When Robin was nine, he went off to boarding school. "It was either that or I had to give up work and go on the dole and look after him," Bruce said. The following year, when Robin came home for the summer, he was always hungry and his mother couldn't say no. "She wouldn't stop feeding him," Bruce said. "The back of the car was littered with the packets." Robin enjoyed the eating, but he was gaining weight at a terrifying pace; he soon weighed nearly three hundred pounds. "It almost destroyed our marriage," Bruce said. Robin became anxious about walking because he was so huge; soon, all his toenails became ingrown. Harriet had an affair. "We've argued so much that it's gone beyond reconciliation," Bruce said. "Harriet is always saying, 'It's time we divorced,' but we never do it, because neither of us could handle this alone."

Then Robin's school was closed down because a child escaped and died, revealing inadequate supervision that would fill any parent with anxiety. Only two schools in the UK would take someone as violent as Robin. Bruce and Harriet selected Hesley Village and College in Yorkshire, a Victorian farm on fifty-four acres with its own little hotel, a village green, a pub, a bistro, a hairdresser, a post office, and a bakery, all for seventy autistic people. The day Robin arrived, one of his new caregivers suggested they go for a walk, and Robin flew at him with a head-butt, jumped on top of him, and knocked him unconscious. Months of self-injury followed. Robin banged his head so hard that he would break through doors, and so frequently that he needed a skull X-ray; he scratched his skin until it bled. Then he got into the rhythm of the place, and the violence abated.

Robin has a lively sexuality. "He masturbates a lot," Bruce said. "He tries to look up your nose; that turns him on. I suppose it's an orifice, he's got that much. He wants to look up mine, and sometimes I let him, just for a minute, so he can get off. I don't want to discourage him, and he has so little pleasure in life and this is something I can do for him, not too difficult if I don't let myself think about the fact that he's my son, and it's about sex. But I don't want to get him obsessed with nostrils, so I try not to do it too often. There is a girl at college-his pace quickens when he sees her. And although she is very noisy, and he is not really good with noise, he goes all coy when she is in the same room." tries to look up your nose; that turns him on. I suppose it's an orifice, he's got that much. He wants to look up mine, and sometimes I let him, just for a minute, so he can get off. I don't want to discourage him, and he has so little pleasure in life and this is something I can do for him, not too difficult if I don't let myself think about the fact that he's my son, and it's about sex. But I don't want to get him obsessed with nostrils, so I try not to do it too often. There is a girl at college-his pace quickens when he sees her. And although she is very noisy, and he is not really good with noise, he goes all coy when she is in the same room."

Robin seems happier at Hesley now, but his erratic behavior continues. A few months before I met Bruce, Robin had come home on a break and couldn't sleep. After he had been awake for four days straight, Bruce and Harriet got a doctor to prescribe some sleeping pills; these enabled him to sleep for about three hours. When he awoke, he was thrashing around and seemed distraught, so Harriet sat on his bed to try to calm him down. He grabbed her hand and bit through her tendon. "She had to go to hospital," Bruce said. "She was shaking, in shock, and nearly unconscious. It was a terrible night." They took Robin back to college and wondered whether the visits home were more than he could handle. "But then he came home again the week before last and he was just lovely, affectionate, and a joy to be with," Bruce said. "He put his dirty plates in the washer. That's huge progress. We become very proud, just as somebody else is if their child gets a first at Cambridge."

In The Cherry Orchard, The Cherry Orchard, Chekhov said, "When many remedies are proposed for a disease, that means the disease is incurable." Autism invites treatments that range from optimism to quackery. The list of such treatments of dubious efficacy is even longer than the list of treatments that bring about improvement, and parents with fantasies of perfect remission put themselves at the mercy of flamboyant visionaries who tout a range of bizarre procedures as breakthroughs. Barry Neil Kaufman and Samahria Lyte Kaufman developed Option Therapy and the associated Son-Rise Program in the 1980s to treat their own son, who they claim was completely cured of his autism; in fact, one commentator claims that doctors who treated the boy expressed doubt that he ever had autism at all. The program costs $2,000 for an initial consultation with parents and then $11,500 for a one-week program with the child. A New York psychiatrist hatched Holding Therapy, in which parents physically restrain children when they exhibit problematical behavior; this seems to exacerbate tension in both children and parents. Bookstores overflow with books such Chekhov said, "When many remedies are proposed for a disease, that means the disease is incurable." Autism invites treatments that range from optimism to quackery. The list of such treatments of dubious efficacy is even longer than the list of treatments that bring about improvement, and parents with fantasies of perfect remission put themselves at the mercy of flamboyant visionaries who tout a range of bizarre procedures as breakthroughs. Barry Neil Kaufman and Samahria Lyte Kaufman developed Option Therapy and the associated Son-Rise Program in the 1980s to treat their own son, who they claim was completely cured of his autism; in fact, one commentator claims that doctors who treated the boy expressed doubt that he ever had autism at all. The program costs $2,000 for an initial consultation with parents and then $11,500 for a one-week program with the child. A New York psychiatrist hatched Holding Therapy, in which parents physically restrain children when they exhibit problematical behavior; this seems to exacerbate tension in both children and parents. Bookstores overflow with books such as as The Horse Boy, The Horse Boy, about a child who was supposedly led out of his autism by shamans in Mongolia. It sometimes seems that every parent whose child is thriving feels compelled to write a hubristic volume effectively called about a child who was supposedly led out of his autism by shamans in Mongolia. It sometimes seems that every parent whose child is thriving feels compelled to write a hubristic volume effectively called What I Did Right What I Did Right. Many such parents generalize from strategies that may only by chance have coincided with their children's "emergence."

While considerable time and money have been poured into such minimally tested behavioral and conceptual methods, these do not in general pose actual physical danger to children. Chelation, however, has great potential to cause long-term harm, and even greater potential to cause unnecessary short-term suffering. This procedure was originally developed to remove heavy metals from the bodies of wounded soldiers during World War I. Synthetic compounds are administered-usually intravenously, but sometimes intramuscularly or orally-to bind to metals, which are then excreted into the blood, urine, and hair. Chelation is recommended by advocates of the theory that a mercury-based preservative used in some vaccines causes autism. Although extensive research has failed to support its efficacy, as many as one in twelve American autistic children is estimated to have undergone chelation. At least one autistic child has died from hypocalcemia-a fatal drop in calcium levels leading to heart failure-during the procedure. Many more have experienced headaches, nausea, and depression. Some parents claim to have observed miraculous improvements as a result of chelation, and those claims, made in sincerity, have led to a burgeoning, often underground, and largely unregulated business in the chemical "detoxification" of autistic children. A patent-pending "protocol" using Lupron-a castration drug that changes the body as profoundly as any medication can-conflates the possible effects of prenatal testosterone on the development of autism with normal puberty. It has been championed by a father-son team despite a lack of any verifiable evidence for its efficacy; finding that their practice constitutes "a danger to the patient community," the Maryland Board of Physicians and authorities in at least six other states have suspended the father's medical license, while the son, who is not a doctor, has been charged with practicing medicine without a license. Other physical interventions-putting children in hyperbaric oxygen chambers, putting them in tanks with dolphins, giving them blue-green algae, or megadosing them on vitamins-are usually neither harmful nor helpful, though they can have dangers, are certainly disorienting, and cost a lot.

The first time I met Amy Wolf, she said of her daughter, Angela, "She has no speech and is frequently incontinent; is in a full-time, round-the-clock-care facility; is beautiful and loves us; and can't be in the world without help for a minute. She walks and enjoys it. She can't button a button. She can sort silverware; can eat with a fork, a spoon is a little tricky; can't cut things; needs a straw a lot of the time. Has very little fear and awareness, so she would walk in the middle of the busy street if you took your eyes off her. She understands more than she can express, how much no one has figured out. She takes pleasure in things. Sometimes she's quite distant. Sometimes she's bright and makes a lot of contact. Sometimes when she sees me, she's overjoyed, which is fantastic. She likes people-just not too many at once. She hates the doctor; hates the dentist; hates the shoe store; hates the hairdresser; hates big parties; hates surprises; hates change in routine-and, generally, seems quite at peace with her life at this point. The first fourteen years were hellacious." facility; is beautiful and loves us; and can't be in the world without help for a minute. She walks and enjoys it. She can't button a button. She can sort silverware; can eat with a fork, a spoon is a little tricky; can't cut things; needs a straw a lot of the time. Has very little fear and awareness, so she would walk in the middle of the busy street if you took your eyes off her. She understands more than she can express, how much no one has figured out. She takes pleasure in things. Sometimes she's quite distant. Sometimes she's bright and makes a lot of contact. Sometimes when she sees me, she's overjoyed, which is fantastic. She likes people-just not too many at once. She hates the doctor; hates the dentist; hates the shoe store; hates the hairdresser; hates big parties; hates surprises; hates change in routine-and, generally, seems quite at peace with her life at this point. The first fourteen years were hellacious."

In 1972, age twenty, Amy decided to leave behind the life of urban sophistication in which she had been brought up in New York and moved to an alternative community in Taos, New Mexico. She married a healer and acupuncturist, and in 1979 became pregnant. When Angela was born, it was immediately clear that there were problems. She was put into a full-body brace to correct a contorted frame, a displaced hip, and what looked like a clubfoot. Angela's body was hypotonic, with loose, elastic muscles that didn't keep her limbs in place, like a rag doll. She didn't walk until she was almost two. Words came, but slowly, and she was pitifully thin. Taos offered few supports. "There were no antidepressants," Amy recalled. "There were no services; no Internet; no therapists. There were outhouses, apricots drying, Indian pueblos, yurts, hippies, Hispanic ancient culture, and Native American ritual. And Angela and me, somehow very far apart from this community that I had held very dear." Her husband, healer though he claimed to be, could not cope with a disabled child, and he fled.

When Angela was three, Amy divorced and brought her back to New York to start again. At that age, Angela had some speech and could recite "Twinkle, Twinkle, Little Star." She could pick out the family car in the street. She was beginning toilet training. Then, bit by bit, it all fell away. She lost speech and became incontinent. Her muscle tone didn't improve. Amy had a long history with substance abuse and she spun out of control. "I was driving, when she was about four, drunk, with her in the backseat, having poured vodka down her throat while she was in the car seat, thinking that I'd kill us both by driving down an embankment into the Long Island Sound," Amy recalled.

Instead, she joined Alcoholics Anonymous and has been sober ever since. With the support of her parents, she began looking for cures. Angela was never aggressive to anyone else, but she was often self-injurious. Mostly, though, she was just "out of control, and sometimes deeply distressed, and generally incomprehensible." When Angela was seven, a colleague told Amy about a Japanese woman, Kiyo Kitahara, who had achieved astonishing improvements with autistic children. She had founded a school in Kichijoji, Japan, a suburb of Tokyo. Amy met with her in Boston. Her interpreter offered, "Mrs. Kitahara says, 'Put your burdens on our shoulders.' Mrs. Kitahara can have Angela speaking within six months, but you will have to bring her to Japan." So Amy and her mother took Angela to Tokyo and entered her in the Higashi School. Amy was then physically blocked from entering the grounds and could see Angela only during her athletic periods, through a barbwire fence. "I stayed in Tokyo and looked at her, every day, through this fence," Amy recalled. "She seemed okay; they had her rollerblading a lot. We subsequently discovered that she was being deprived of water to toilet-train her. It all got very dark and strange. It took five months, and then I just gathered my precious child and got the hell outta Dodge." A Higashi School was later established in Boston, but has been repeatedly dogged by allegations of physical cruelty and assault on its disabled students. Angela was never aggressive to anyone else, but she was often self-injurious. Mostly, though, she was just "out of control, and sometimes deeply distressed, and generally incomprehensible." When Angela was seven, a colleague told Amy about a Japanese woman, Kiyo Kitahara, who had achieved astonishing improvements with autistic children. She had founded a school in Kichijoji, Japan, a suburb of Tokyo. Amy met with her in Boston. Her interpreter offered, "Mrs. Kitahara says, 'Put your burdens on our shoulders.' Mrs. Kitahara can have Angela speaking within six months, but you will have to bring her to Japan." So Amy and her mother took Angela to Tokyo and entered her in the Higashi School. Amy was then physically blocked from entering the grounds and could see Angela only during her athletic periods, through a barbwire fence. "I stayed in Tokyo and looked at her, every day, through this fence," Amy recalled. "She seemed okay; they had her rollerblading a lot. We subsequently discovered that she was being deprived of water to toilet-train her. It all got very dark and strange. It took five months, and then I just gathered my precious child and got the hell outta Dodge." A Higashi School was later established in Boston, but has been repeatedly dogged by allegations of physical cruelty and assault on its disabled students.

Amy held on to her dream of a healthy child. "Another baby I craved; another baby I had. Until I had Noah, I was in psychological pain continuously. And the decision to have him helped with the scars." She found pregnancy terrifying and was "tested to within an inch of my life," she recalled. Amy's parents paid to construct a group home to be managed by the Nassau County Mental Health Association, and eleven-year-old Angela moved there shortly before Noah was born. When I met Noah, he was in high school and doing volunteer work as a music therapist for autistic children. "From the age of six, he would see someone blind and cross the street to help them," Amy said. "He is opened up spiritually, yet free of all the rage that I still hold." Noah concurred, "It's just taught me a lot of tolerance and acceptance. Like if someone says 'retarded' around Mom-God, it's like unnecessarily stupid what she does. Even if she's known the person for five seconds, she just goes for it."

"In all my dreams of her, she talks to me still," Amy said. "Letting go of speech was terrible. And letting go of the toileting just happened this year. Letting go is a continuous experience: it never finishes. I have to keep my rage in check; I have to keep my sobriety in check. I've experienced close family members suggesting that I kill her, and they would help me. I've experienced people offering the most idiotic possible cures: stuff to put in the bathtub, and gripe water, and handing me copies of copies of When Bad Things Happen to Good People, When Bad Things Happen to Good People, and bullshit galore. I've also experienced the great inequity in the way our pay scales are structured, since the people who do the hands-on clinical work with this population are so energetic, and so frequently expert, and inspired, and they're making what waiters and waitresses make. A good measure of a society is how well it takes care of its sick people. Our society is an outrage." Amy spoke with the passion of someone running for office. "My story includes a continuous heartache that transcends everything else. There's no sense of time; it's just the same and the same. I forget how old I am, because I can't measure it in these ways." and bullshit galore. I've also experienced the great inequity in the way our pay scales are structured, since the people who do the hands-on clinical work with this population are so energetic, and so frequently expert, and inspired, and they're making what waiters and waitresses make. A good measure of a society is how well it takes care of its sick people. Our society is an outrage." Amy spoke with the passion of someone running for office. "My story includes a continuous heartache that transcends everything else. There's no sense of time; it's just the same and the same. I forget how old I am, because I can't measure it in these ways."

While the deficits of autism are famous, the general public is less aware that people with autism may also have major abilities that the rest of us lack. Autistic subjects tend to perform better than others on certain cognitive tests, such as spatial-thinking assessments. Joyce Chung, whose daughter has autism and who served as autism coordinator at the NIMH, said, "If you removed the capacity for someone to become autistic, would that also remove the things that make us interesting as human beings? Maybe the same genetic structures also produce creativity and diversity." Thorkil Sonne, an executive in a Danish telecommunications firm and the father of an autistic child, has set up a specialist agency in Copenhagen that places people with autism on corporate projects, presenting them not as deficient individuals to be hired out of charity, but as people with singular skills.

But the notion of uncanny genius can also be used to objectify autistic people. John Elder Robison writes, "Being a savant is a mixed blessing, because that laser-like focus often comes at a cost: very limited abilities in nonsavant areas. Some of my designs were true masterpieces of economy and functionality. Many people told me they were expressions of a creative genius. And today I can't understand them at all. My story isn't sad, though, because my mind didn't fade or die. It just rewired itself. I'm sure my mind has the same power it always did, but in a more broadly focused configuration." I have heard Temple Grandin say the same thing, and my friend who played the Philip Glass CD told me that as his social abilities improved, his pure mathematical thinking weakened. The cure can be its own disease: when you take away what's perceived as wrong, you may also take away the person's gift.

I first met Temple Grandin when she was sixty, and famous for her ability to narrate her own autistic consciousness to nonautistic people. A cattle handler and livestock-facilities designer whose equipment is now used in the majority of US slaughterhouses, Grandin claims that she experiences fear as her primary emotion and has an overdeveloped startle reflex of the kind that protects animals from predators. "I think in pictures," she said. "I realized that should be able to help me figure about animals, because I think more the way an animal does." The cattle industry struck her as both inefficient and inhumane. Her objective has always been to improve the treatment of animals, which she believes she can do most effectively by reforming the places where they are killed. she experiences fear as her primary emotion and has an overdeveloped startle reflex of the kind that protects animals from predators. "I think in pictures," she said. "I realized that should be able to help me figure about animals, because I think more the way an animal does." The cattle industry struck her as both inefficient and inhumane. Her objective has always been to improve the treatment of animals, which she believes she can do most effectively by reforming the places where they are killed.

When she was diagnosed as a child in the early 1950s, Temple showed the full range of autistic symptoms, and her mother, Eustacia Cutler, was told that she was a refrigerator mother. Eustacia could cope with Temple's strange behavior, but not with the emotional chill. "Tantrums are hard to handle, and fecal smears are smelly, but exclusion breaks the heart," Eustacia wrote in a memoir. "'Be fruitful and multiply,' God whispers in our ear, and leaves us to deal with the mess." Temple recalled, "When I was two and a half, I would sit there smelling space, eating carpet fuzz, screaming, stereotypic behavior." Her mother invented her own behaviorist system to help Temple, and she and the nanny she hired kept Temple constantly interacting. When I met Eustacia, she explained, "You have to pull them out of the limbo of their self-absorption." Temple was given art lessons and showed a talent for perspective drawing. Her mother did all she could to encourage this skill. "You want to be appreciated for doing something other people want," Temple recalled. "When the kid is really little, you've got to get somebody to just spend thirty-eight hours a week working with that kid, keeping them engaged. I don't think the method matters that much."

She expresses considerable gratitude for the attentions she received. "They put kids like me in institutions then. I had fifteen years of nonstop panic attacks, which was hard on everyone. If I hadn't found anti-depressants in my early thirties, I would have been ripped apart by stress-related health problems, like colitis. I was very lucky to get some really good mentors when I was in college." She paused and looked at me as though she had just surprised herself. "I mean, what would have happened to me if my mother had put me away instead? I hate to even think about it." Eustacia found that she had to invent everything. "Why didn't the doctors know as much as I did?" she wondered when we spoke. As an adolescent, Temple said to her mother, "I can't love." Eustacia wrote, "Adolescence is hard enough for any child, but autistic adolescence is something devised by the devil." But Temple's boarding school had a stable full of abused horses that the headmaster had bought cheaply, and Temple found her joy in caring for them.

Many years later, Eustacia could admire whom Temple had become. "Slowly, with no innate concept, no intuitive clue-conscious intelligence her only guide, and even then not sure-she's taught herself over the years 'to meet the faces that you meet.' How bright and brave of her to want to meet us anyway, armed with such a flimsy, homemade mask. Autism is an exaggeration of what lies in us all. And studying it has been my form of exorcism." This does not mean that it has been free of disappointments. "Despite her extraordinary accomplishments, she knows that some part of the dream that I call 'life' lies a little beyond her. It accounts for her hunger to have me understand her her dream: that she won't be forgotten. Her longing for some kind of recognition is so palpably real. As if love were too shaky and mysterious to rely on." dream: that she won't be forgotten. Her longing for some kind of recognition is so palpably real. As if love were too shaky and mysterious to rely on."

Temple receives thousands of letters from parents and readily offers advice. "Some of these kids, you've got to jerk them out of it. If you're not somewhat intrusive, you're not going to get anywhere with them," she said. Temple advocates behavioral and medical treatments, and anything to engender literacy. "Your kid is throwing a fit in Walmart because he feels like he's inside the speaker at a rock concert. He's seeing like a kaleidoscope; hearing's fading in and out, and full of static. I think some of those kids are getting scrambled HBO, but every once in a while, you get a little bit of an image in that scrambled HBO." Temple believes firmly that the higher-functioning you can make someone, the happier he is likely to be. Autistic children should develop skills consistent with their capacities. "You've got a kid who loves geology. Well, instead of developing his interest into a career, parents and teachers and therapists get hung up on social-skills training. And social-skills training's really important. But don't get so hung up on that, that you neglect his gifts." Temple Grandin attributes her success to her autism; "Genius is an abnormality, too," she explained to me. Without being self-aggrandizing, Temple has made what the world calls illness the cornerstone of her brilliance.

Into all of this comes the neurodiversity movement, with its celebration of some aspects of autism. One of the leading autism charities was called Cure Autism Now, since merged with Autism Speaks. While opposing a cure for autism is a bit like opposing intergalactic travel, one of the battle cries of neurodiversity is "Don't cure autism now." Like the rest of identity politics, this is an attitude forged and burnished in opposition to prejudice, treading a fine line between revealing a fundamental truth and attempting to create that truth. Conservatives complain that asking the larger society to accept autistic people's atypical social logic undermines the very principles that make it a society; members of the neurodiversity movement take exception to the idea that autistic behavior lacks social coherence and maintain that it is a different and equally valid system. They fight for their own definition of civil justice. of the neurodiversity movement take exception to the idea that autistic behavior lacks social coherence and maintain that it is a different and equally valid system. They fight for their own definition of civil justice.

Thomas Insel said, "It's really important that we recognize schizophrenia, bipolar disorder, or autism as something that's happened to someone, that there's still a someone there who can fight against the illness." Jim Sinclair, an autistic adult and the cofounder of Autism Network International, wrote, "Autism isn't something a person has, has, or a 'shell' that a person is trapped inside. There's no normal child hidden behind the autism. Autism is a way of being. It is or a 'shell' that a person is trapped inside. There's no normal child hidden behind the autism. Autism is a way of being. It is pervasive pervasive; it colors every experience, every sensation, perception, thought, emotion, and encounter, every aspect of existence. It is not possible to separate the autism from the person-and if it were possible, the person you'd have left would not be the same person you started with." The politically correct terminology in most of the world of disability is to identify the person ahead of the condition: you speak of a "person with deafness" rather than a "deaf person," or a "person with dwarfism" rather than a "dwarf." Some autism advocates take issue with the idea that they are "a self with something added," preferring "autistic person" to "person with autism." Others favor autistic autistic as a noun, as in, "Autistics should receive social accommodation." Sinclair has compared "person with autism" to describing a man as a "person with maleness" or a Catholic as a "person with Catholicism." as a noun, as in, "Autistics should receive social accommodation." Sinclair has compared "person with autism" to describing a man as a "person with maleness" or a Catholic as a "person with Catholicism."

Many neurodiversity activists question whether existing treatments are for the benefit of autistic people or for the comfort of their parents. Idiosyncrasies may be unsettling, but how much torment should a child go through to relinquish them? Isabelle Rapin said of her adult patients, "We shouldn't impose our values of success onto people who really have very different needs." Joyce Chung, who has an autistic daughter, said, "Our struggle was not to let ourselves experience our child's condition as a narcissistic injury." In other words, the autism is something that has happened to the child rather than to the parents. Alex Plank, who has Asperger syndrome and whose Wrong Planet website, an affirming forum for people with autism and their families, has over forty-five thousand members, said, "The organizations that have the best connections are the ones founded by parents of people with autism, which aren't going to have the same priorities as the autistic people themselves, especially if those parents' idea of success is to make their kid the same as the parents were when they were kids." Ari Ne'eman, who has Asperger syndrome and became a prominent self-advocate while still in college, uses the colloquial Aspie Aspie to describe himself. He said, "Society has developed a tendency to examine things to describe himself. He said, "Society has developed a tendency to examine things from the point of view of a bell curve. How far away am I from normal? What can I do to fit in better? But what is on top of the bell curve? Mediocrity. That is the fate of American society if we insist upon pathologizing difference." from the point of view of a bell curve. How far away am I from normal? What can I do to fit in better? But what is on top of the bell curve? Mediocrity. That is the fate of American society if we insist upon pathologizing difference."

In December 2007, the NYU Child Study Center produced a series of advertisements for their treatment program in the form of ransom notes. One ominously announced, "We have your son. We will make sure he will not be able to care for himself or interact socially as long as he lives. This is only the beginning." It was signed "Autism." Another said, "We have your son. We are destroying his ability for social interaction and driving him into a life of complete isolation. It's up to you now," and was signed "Asperger Syndrome." Harold Koplewicz, then director of the center, hoped to propel children with untreated mental health problems into the hands of competent professionals. But the ads were judged demeaning and stigmatizing by many people, including some with autism spectrum disorders. Autism activists spearheaded a campaign against them; the chief organizer was Ne'eman. In a memo to the members of his Autistic Self Advocacy Network, he wrote, "This highly offensive ad campaign relies on some of the oldest and most offensive disability stereotypes to frighten parents into making use of the NYU Child Study Center's services. While people with diagnoses of autism and Asperger's often have difficulty with some forms of social interaction, we are not incapable of it and can succeed and thrive on our own terms when supported, accepted and included for who we are."

Ne'eman initiated a letter-writing campaign and recruited major American disability groups to support his position. The campaign rapidly escalated and was soon reported in the New York Times, New York Times, the the Wall Street Journal, Wall Street Journal, and the and the Washington Post Washington Post. Koplewicz was stunned by the protests. On December 17, he insisted the ads were there to stay, but the revolt was escalating, and two days later they were pulled. It was a signal triumph for the neurodiversity movement, and for the broader community that endorses disability rights. In the aftermath of the debacle, Koplewicz conducted an online town-hall meeting, and more than four hundred people participated.

Ari Ne'eman is not without social graces, but you can feel the effort in them. He said, "Neurotypical social interaction is like a second language. One can learn a second language with great fluency, but no one will ever be as comfortable in it as in one's own tongue." When Ne'eman was in high school, his intellectual skills, social deficits, and unusual learning style meant that he was considered both disabled and gifted, which made for trouble figuring out what classes he should take. "There's this stereotype out there of the shiny Aspie, but you have to recognize and respect human difference, and the diversity of human neurology, regardless of whether somebody's academically brilliant," Ne'eman said. "As a public relations point, it's nice to have Vernon Smith, who has Asperger's and won the Nobel in economics, or Tim Page, who has Asperger's and won a Pulitzer. It's have to recognize and respect human difference, and the diversity of human neurology, regardless of whether somebody's academically brilliant," Ne'eman said. "As a public relations point, it's nice to have Vernon Smith, who has Asperger's and won the Nobel in economics, or Tim Page, who has Asperger's and won a Pulitzer. It's a a point in favor of respecting and recognizing the legitimacy of human neurological diversity. But it would be a deep mistake to say that people should have their differences respected point in favor of respecting and recognizing the legitimacy of human neurological diversity. But it would be a deep mistake to say that people should have their differences respected only only if they can deliver some special talent." In 2010, age twenty, Ne'eman was appointed by President Obama to the National Council on Disability. His selection met a firestorm of criticism from those who argued that his positive characterization of autism would reduce funds needed to treat their children. if they can deliver some special talent." In 2010, age twenty, Ne'eman was appointed by President Obama to the National Council on Disability. His selection met a firestorm of criticism from those who argued that his positive characterization of autism would reduce funds needed to treat their children.

The term neurodiversity neurodiversity was originally coined by Judy Singer, an Australian sociologist whose mother and daughter both have Asperger's and who is herself on the spectrum. "I was at a workshop at a synagogue where they were trying to get us to come up with a better set of Ten Commandments than God's," she said. "My first was 'Honor diversity.'" Singer and the American journalist Harvey Blume were thinking along parallel lines, and though she first used the word, he was the first to publish it, in 1998. "We both noticed that psychotherapy was waning and neurology was on the rise," Singer said. "I was interested in the liberatory activist aspects of it-to do for people who were neurologically different what feminism and gay rights had done for their constituencies." The movement accelerated with the broadening of the spectrum, and with increased communication among autistic people. "The Internet," Singer said, "is a prosthetic device for people who can't socialize without it." For anyone challenged by language and social rules, a communication system that does not operate in real time is a godsend. was originally coined by Judy Singer, an Australian sociologist whose mother and daughter both have Asperger's and who is herself on the spectrum. "I was at a workshop at a synagogue where they were trying to get us to come up with a better set of Ten Commandments than God's," she said. "My first was 'Honor diversity.'" Singer and the American journalist Harvey Blume were thinking along parallel lines, and though she first used the word, he was the first to publish it, in 1998. "We both noticed that psychotherapy was waning and neurology was on the rise," Singer said. "I was interested in the liberatory activist aspects of it-to do for people who were neurologically different what feminism and gay rights had done for their constituencies." The movement accelerated with the broadening of the spectrum, and with increased communication among autistic people. "The Internet," Singer said, "is a prosthetic device for people who can't socialize without it." For anyone challenged by language and social rules, a communication system that does not operate in real time is a godsend.

Camille Clark, who blogged for some years as Autism Diva, is diagnosed with Asperger syndrome, has been an important voice for neurodiversity, and is mother to an adult child with autism and spina bifida. "Autistic children love their parents," she said. "You may have to learn to see how your child expresses affection and not take it personally if your child doesn't show affection as typical children do. Deaf children may never speak the words 'I love you,' and deaf parents may never hear those words, but that doesn't mean that deaf children don't love their parents. For many Asperger syndrome and autistic people, just being in the presence of others is as much work as it is for a normally social NT [neurotypical] person to host a big party." Many autistic people find eye contact unsettling; Kathleen Seidel, founder of Neurodiversity.com, said that she learned to avert her own gaze as a means of respecting her son's needs. He, in turn, knew that physical contact had value to her and would occasionally give her a hug. her son's needs. He, in turn, knew that physical contact had value to her and would occasionally give her a hug.

Clark feels that the concept of neurodiversity extends well beyond autism. "People with bipolar, schizophrenia, dyslexia, Tourette's, and so forth ought to 'subscribe' to it," she wrote to me. "Parents of autistic kids should be reasonable about what they can or can't do, and they shouldn't expect that their kid is ever going to be 'normal.' Autistic people are valuable as they are. They don't have value only if they can be transformed into less obviously autistic people." Jim Sinclair wrote, "The ways we relate are different different. Push for the things your expectations tell you are normal, and you'll find frustration, disappointment, resentment, maybe even rage and hatred. Approach respectfully, without preconceptions, and with openness to learning new things, and you'll find a world you could never have imagined." One activist commented to me that the attempts to "cure" autistic people are less like a cure for cancer than a cure for left-handedness.

Many neurodiversity activists fear that in the event of a genetic test, selective abortion would result in "genocide." "I don't want to get old and know that there will be no more people like me being born," said Gareth Nelson, a man with Asperger syndrome who cofounded the website Aspies For Freedom. As with most of the conditions in this book, the abortion question is emblematic of the tension between identity and illness models. Ne'eman said, "We have never said that autism does not represent a disability, but that it doesn't represent a disease. Give autistic individuals the educational opportunities and the opportunities to prosper and do well on our own terms." Seidel said, "I have never ruled out the possibility that genetic research might yield helpful therapies for problems often experienced by autistic people. I'm all for the development of antagonists that might, for example, correct impairments in oral-motor function or serotonin metabolism, alleviate chronic anxiety, reduce a tendency to overstimulation, or decrease aggression. But I am primarily concerned about how to make life positive for the people on the autism spectrum who are here now, a group that happens to include my own child."

Some parents of severely autistic children dismiss the articulate self-advocates as not really being autistic. There's a central irony here. The increased rate of diagnosis is crucial to the claim that there is an epidemic-critical in lobbying for resources for research. But the higher-functioning people whose inclusion has brought up the numbers are often the ones who advocate against some of that research. Roy Richard Grinker, husband of Joyce Chung and author of Unstrange Minds, Unstrange Minds, a book arguing that there is no epidemic, said, "At both ends of that spectrum, a book arguing that there is no epidemic, said, "At both ends of that spectrum, there's an antiscience perspective. The neurodiversity people are furious that the scientists want to cure autism; the antivaccine people are furious that the scientists won't do the studies they know should be done. Their premises are so different that any true dialogue is impossible. They're unable to speak with each other because they have such different epistemological and philosophical foundations." there's an antiscience perspective. The neurodiversity people are furious that the scientists want to cure autism; the antivaccine people are furious that the scientists won't do the studies they know should be done. Their premises are so different that any true dialogue is impossible. They're unable to speak with each other because they have such different epistemological and philosophical foundations."

Thomas Insel said, "This is the most polarized, fragmented community I know of. I think those kids have something seriously wrong with them. And when you start to argue that they just need to be accepted for who they are, you're selling them and yourself terribly short. I don't think we would do that with most cancers, or with infectious diseases. I sure hope we don't do it for people who have a brain disorder like this. Most parents want their kids to live the fullest life possible, and that's not possible when you're not toilet-trained. And it's not possible when you don't have any language."

"Please don't write about them," Lenny Schafer, editor of the Schafer Autism Report, Schafer Autism Report, said to me when I mentioned neurodiversity. "They're a handful of noisy people who get a lot of media attention. They're trivializing what autism really is. It's like stealing money from the tin cup of a blind man when you say that it's not an illness; you are getting the people who should be making political and social change to think that it's not a problem. You are slowing down funding for research." Other critics are even more vehement. John Best, parent of a child with autism, is author of the said to me when I mentioned neurodiversity. "They're a handful of noisy people who get a lot of media attention. They're trivializing what autism really is. It's like stealing money from the tin cup of a blind man when you say that it's not an illness; you are getting the people who should be making political and social change to think that it's not a problem. You are slowing down funding for research." Other critics are even more vehement. John Best, parent of a child with autism, is author of the Hating Autism Hating Autism blog. One recent post showed a monkey engaged in autofellatio labeled "A neurodiverse nitwit ponders the vaccine trial." The antineurodiversity, antigenetics blog. One recent post showed a monkey engaged in autofellatio labeled "A neurodiverse nitwit ponders the vaccine trial." The antineurodiversity, antigenetics Age of Autism Age of Autism blog featured a Thanksgiving card with a photoshopped image of Alison Singer, Thomas Insel, and others who don't support the vaccine hypothesis eating a baby for their holiday meal. blog featured a Thanksgiving card with a photoshopped image of Alison Singer, Thomas Insel, and others who don't support the vaccine hypothesis eating a baby for their holiday meal.

Seidel referred to Insel's assertion that autism "takes away the soul of the child" as a "histrionic and stigmatizing assertion." She explained, "I don't believe that he has ever cited any specific examples of parents whose 'overacceptance' has led them to neglect their children's medical needs, or to deprive their children of an appropriate education, or to allow their children to descend into a state of self-indulgent incontinence, or to prevent their children from learning to communicate as best they can, or to stymie research into the causes and treatment of specific problems associated with autism. People such as Lenny Schafer set up this straw man saying, 'Oh, the neurodiversity people just want to let autistic kids rot in the corner and never have anything that will help them.' That's bullshit. No parent in their right mind would let their kid rot in a corner."

On the other side, Kit Weintraub, who has two children with autism, wrote, "The fact that my children have an abnormality of development does not mean that I do not love my children for who they are. As with any other condition that would threaten their future and their happiness, I do as much as I can to help them be as functional and as normal as possible. And no, 'normal' to me does not mean 'a cookie-cutter robot-child, trained to do my will.' It means: 'able, like most people without autism, to lead an independent, purpose-filled life-able to speak, able to communicate, able to form and keep relationships.'"

Some autistic people resent the perception that the activists who celebrate aspects of autism are speaking on their behalf. Jonathan Mitchell, an autistic man who wars with the neurodiversity movement on his blog, said, "The neurodiverse reach a vulnerable audience as many persons on the spectrum have been disaffected from society. Autistic people feel worthless and have low self-esteem and neurodiversity provides a tempting escape valve. The same is true for parents of sometimes severely autistic children who want to see their offspring as something other than deficient or broken." Of course, the broader disability rights movement can be intolerant of science; Judy Singer said, "I fell out with the disability rights movement because they were so sociologically oriented; they were almost the same as creationists in their hatred of biology." Members of the neurodiversity movement, though, do not in most instances deny biology; the presence of the prefix neuro neuro makes it clear that biology is part of the argument. What they probe is the meaning of that biology. makes it clear that biology is part of the argument. What they probe is the meaning of that biology.

Much of the antipathy results from divergent ideas of love. Many people who champion ABA or support the vaccine hypothesis believe that families who don't accept their views are consigning their children to ruin. Many neurodiversity activists think that ABA is dehumanizing and the vaccine hypothesis is insulting. Clark has argued that ABA is suitable only for animals. Seidel believes that the parents who describe their autistic children as vaccine victims are disparaging their own progeny: "I am very concerned about the long-term, deep psychological impact on my child of the proliferation of the erroneous concept that people on the autism spectrum are poisoned. It's scientifically incorrect and symbolically offensive."

It's nave to criticize some autism activists for being autistic-idiosyncratic, single-minded, detail-oriented, not predisposed to imagine how listeners might respond to their words, and reluctant to compromise on a position unless offered a rational, intellectually supportable reason to do so. These qualities make autistic people somewhat less persuasive activists than they might wish, activism being in general helped considerably by charm. It's harder to account for the aggression of the antineurodiversity movement. Schafer complains that neurodiversity activists "see us as being less than loving, as evil, and that's just not who we are." Yet it is the antineurodiversity people who, on the helped considerably by charm. It's harder to account for the aggression of the antineurodiversity movement. Schafer complains that neurodiversity activists "see us as being less than loving, as evil, and that's just not who we are." Yet it is the antineurodiversity people who, on the Evidence of Harm Evidence of Harm discussion list on Yahoo!, have accused their opponents of being "lazy," "vaccine barbarians," "cheap whores," "motivated only by a paycheck," and "high-minded Fascist germ freaks" disseminating "malicious public relations hyperbole." discussion list on Yahoo!, have accused their opponents of being "lazy," "vaccine barbarians," "cheap whores," "motivated only by a paycheck," and "high-minded Fascist germ freaks" disseminating "malicious public relations hyperbole."

Sarah Spence, a pediatric neurologist who worked at the NIMH, said, "When we mitigate some of the underlying symptoms for people with severe autism, they do seem happier. As a clinician, you don't feel that they love being 'in their world.' They want to break out. We'd like to accommodate the politics of neurodiversity, but science and clinical support have to go before politics." Simon Baron-Cohen said, "Autism is both a disability and a difference. We need to find ways of alleviating the disability while respecting and valuing the difference."

The attempt to dictate black-and-white policy about a spectrum condition is inherently flawed. Some people are frustrated by not being able to communicate well, and some seem not to mind; others accept that speech is difficult or impossible for them and communicate with keyboards and other assistive technologies; others yet, by careful observation, develop enough skills to get by. Some people are shattered by their social deficits, and others are largely uninterested in friendship, and others still make friends in their own way. Some people are devastated by their autism, some are proud of their autism, and some simply accept it as a fact of their life. There is social conditioning here: those who are regularly disparaged are less likely to feel good about themselves than those who receive supportive messages. But there is also a question of personality. Some autistic people are optimistic and buoyant, and some are withdrawn and depressed; autism coincides with the full personality range to be found in the neurotypical population.

Steven Hyman said, "Severity, of course, matters. A certain amount is your life goals and whether you can achieve them, and whether you're experiencing distress and disability as a result of how you think and feel or whether you are happy with the way you are." Insel said, "For those who are most disabled, the neurodiversity approach is threatening. On the other end of the spectrum, it will help people to accept themselves in the same way it encourages us to accept their uniqueness. What I'm hearing from some part of that community is that if you accept us for who we are, it also means that you'll help us to become everything we can be." Jennifer Franklin, mother of Anna, spoke with passion about such manifestos. "If Anna Livia were an adult who wanted to wear diapers and not be potty-trained, I'm down with anything. I'd like nothing more than for her to develop the kind of consciousness that would allow her to join the neurodiversity movement. If Anna got to the point where she could tell a therapist, 'My mom is a bitch for putting me through this,' I would feel like I did my job." such manifestos. "If Anna Livia were an adult who wanted to wear diapers and not be potty-trained, I'm down with anything. I'd like nothing more than for her to develop the kind of consciousness that would allow her to join the neurodiversity movement. If Anna got to the point where she could tell a therapist, 'My mom is a bitch for putting me through this,' I would feel like I did my job."

Grandin argues that both the autistic person and the society have to make accommodation. She described the suffering of people who couldn't communicate, had toileting challenges, and were injuring themselves regularly. "It would be nice if you could prevent the most severe forms of nonverbal autism," she said. "But if you got rid of all the autism genetics, you'd get rid of scientists, musicians, mathematicians, and all you'd have left is dried-up bureaucrats. I see a picture in my mind of the cavemen talking around the campfire, and off in the corner, there's the Aspie guy, and he's chipping the first stone spear, figuring out how to tie it to a stick, cutting some animal sinews to do it. Social people don't make technology."

In a rebuttal of the suggestion that only those with few of the problems experienced by severely impaired autistic people are active in the neurodiversity community, however, the three webmasters of autistics.org issued a statement affirming that none of them is fully toilet-trained, and that one has no speech. "We flap, finger-flick, rock, twist, rub, clap, bounce, squeal, hum, scream, hiss and tic," they wrote, asserting that such behaviors do not impede their happiness. In a video called issued a statement affirming that none of them is fully toilet-trained, and that one has no speech. "We flap, finger-flick, rock, twist, rub, clap, bounce, squeal, hum, scream, hiss and tic," they wrote, asserting that such behaviors do not impede their happiness. In a video called In My Language, In My Language, the neurodiversity activist Amanda Baggs described her perspective. Baggs has repetitive behaviors and no speech. "The way I think and respond to things looks and feels so different from standard concepts that some people do not consider it thought at all," she says. "It is only when I type something in your language that you refer to me as having communication. People like me are officially described as mysterious and puzzling, rather than anyone admitting that it is themselves who are confused. Only when the many shapes of personhood are recognized will justice and human rights be possible." the neurodiversity activist Amanda Baggs described her perspective. Baggs has repetitive behaviors and no speech. "The way I think and respond to things looks and feels so different from standard concepts that some people do not consider it thought at all," she says. "It is only when I type something in your language that you refer to me as having communication. People like me are officially described as mysterious and puzzling, rather than anyone admitting that it is themselves who are confused. Only when the many shapes of personhood are recognized will justice and human rights be possible."

Jane Meyerding, who is diagnosed with Asperger syndrome and works at the University of Washington, wrote, "If people on the autism spectrum all 'came out' and worked towards increasing institutional flexibility to the point where our 'special needs' could be accommodated, the world would be a much more comfortable, less alienating place for everyone else as well. Such a world would be one where it would be as normal for children to have different learning styles as it is to have different colors and textures of hair. Where everyone would 'have an accent.'" Joyce Chung described how her daughter, when "struggling over something she can't quite articulate," finally explained, "I think that's because of my autism, Mama." Would such a statement have been possible twenty years ago, and is the capacity for such self-accepting self-awareness a hallmark of maturity, liberation, even of triumph over the illness? "When people pity me for my daughter, I don't understand the sentiment," Roy Richard Grinker wrote. "Autism is less a disease to be hidden than a disability to be accommodated; it is less a stigma, reflecting badly on her family, than a variation of human existence." would 'have an accent.'" Joyce Chung described how her daughter, when "struggling over something she can't quite articulate," finally explained, "I think that's because of my autism, Mama." Would such a statement have been possible twenty years ago, and is the capacity for such self-accepting self-awareness a hallmark of maturity, liberation, even of triumph over the illness? "When people pity me for my daughter, I don't understand the sentiment," Roy Richard Grinker wrote. "Autism is less a disease to be hidden than a disability to be accommodated; it is less a stigma, reflecting badly on her family, than a variation of human existence."

Kate Movius, mother of an autistic child, wrote, "Nothing yet has yielded a 'eureka!' moment for Aidan, unveiled some ideal child beneath the autism. Instead it is I who have been revealed, rebuilt, and given a new way of not just seeing Aidan for who he is, but of seeing myself." Kathleen Seidel said, "The word incurable incurable is quite devastating-sounding, but you can also look at it as being that autism is durable. Looking at this jewel through different facets does not trivialize the challenges of people who have tremendous obstacles. I'm trying to look at the whole picture, including the beautiful part of it. Autism is as much a part of our humanity as the capacity to dream. God manifests all possibilities, and this is one of the possibilities in our world. It's a part of the human condition-or conditions, as the case may be." is quite devastating-sounding, but you can also look at it as being that autism is durable. Looking at this jewel through different facets does not trivialize the challenges of people who have tremendous obstacles. I'm trying to look at the whole picture, including the beautiful part of it. Autism is as much a part of our humanity as the capacity to dream. God manifests all possibilities, and this is one of the possibilities in our world. It's a part of the human condition-or conditions, as the case may be."

For the Deaf, medicine and activism are both galloping; for autistic people, both are trudging. Unlike deafness, autism has not been established as a culture in the eyes of even the liberal outside world. There is no formal language of autism to be recognized by linguists. There is no university with a long history of educating autistic people (unless one counts MIT). Institutions parallel to those that subtend the Deaf claim to culture-Deaf theater, Deaf social habits, Deaf clubs-are not in place for autistics. The complexity of the science means that autism has time before medical progress trumps identity politics, but the Deaf model should make it clear to the neurodiversity crowd that they are in a race, in which their primary advantage is the other side's tortoiselike pace. The autistic have on their side as well, however, the very real achievements of autistic people; retrospective diagnosis, albeit shaky science, suggests that Mozart, Einstein, Hans Christian Andersen, Thomas Jefferson, Isaac Newton, and a great many other visionaries would now be diagnosed on the spectrum. Describe a world without Helen Keller and most people wouldn't miss her so much; describe a world without those particular geniuses, and everyone would be impoverished.

Bill Davis grew up in the Bronx, found his way into street gangs, and then graduated into organized crime. One day in 1979, a twenty-year-old would-be model walked into the nightclub he was managing. "She took a carnation out of a vase, put it in my lapel, and said, 'You're with me.' We've been together ever since," he said. After ten years, Bill and Jae moved to Lancaster, Pennsylvania, where their daughter, Jessie, was born. Five years later, their son, Christopher, followed. Jae stayed home with the children; Bill tended bar. At two, Chris stopped talking. By two and a half, he was rocking back and forth in a corner. Jae recognized that something was seriously wrong, and though she had no driver's license, she announced one morning that she was driving Chris to Philadelphia to visit the Seashore House, a children's hospital. She didn't get a satisfactory answer, so two days later she said, "I'm going to Kennedy Krieger in Baltimore, and if that doesn't work, we're heading down to Haddonfield, New Jersey, to the Bancroft School." Bill said, "You can't drive around without a license." The next week, she passed the test. "It turned out those places were the top in the country, but when and how did she figure that out?" Bill said. "And learn traffic laws at the same time?"

Chris didn't sleep. He flapped his hands. He injured himself. He smeared himself with feces and flung it at his parents. He bit himself. He gouged at his eyes. He stared at the ceiling fan for hours on end. Jae had intuited that Chris would need infinite patience, and a progressive approach to things he found difficult, including intimacy itself. She and Bill broke everything into small tasks. "It was like, 'Can I just touch you?' 'Oh, thank you so much. You're great,'" Bill said. "He wouldn't walk to the end of the block. So I would take him half a block and say, 'What a great walk!'"

Chris had difficulty understanding cause and effect. He liked the motion of the car and screamed every time it stopped for a red light. Jae made red and green cards, and whenever the car approached a red light, she would show him the red one, and when it was time to go, she would show him the green. Once he understood the correlation, the screaming stopped. Jae gathered that he could absorb visual information, and she came up with a system of flash cards and symbols. "I was always watching what he saw," Jae said. She had become interested in the work of Vincent Carbone, a behavior analyst, so she drove to Penn State and cornered him in his office. When he said, "Lady, I've got to go," she said, "You don't understand. I'm not letting you out of your office until you agree to help me." After resisting for an hour, he told her she could join his next course. She stayed for a week and over the next few years developed several useful variations on his methodology. Carbone became so interested in these modifications that he sent a team up to Lancaster to observe her work with Chris. When Chris was six, Jae started taking in other autistic children. She found that one nonverbal boy liked clocks, so she bought him clocks and praised his interest. One day, he suddenly said to himself, "Good job, Juan." It was the beginning of speech. Carbone became so interested in these modifications that he sent a team up to Lancaster to observe her work with Chris. When Chris was six, Jae started taking in other autistic children. She found that one nonverbal boy liked clocks, so she bought him clocks and praised his interest. One day, he suddenly said to himself, "Good job, Juan." It was the beginning of speech.

Jae recruited interns at Franklin and Marshall College and Rutgers University to help implement her techniques, tutoring and directing them in their work at the house. She set up cameras in Chris's room and filmed the students so that she could correct their errors. She brought them to conferences and training programs. She wrote recommendation letters for them as they applied to grad school. By the time Chris was grown, Jae had trained more than forty interns; as other families in the area became aware of her work, she placed interns with them, as well.

Jae refused to believe that if Chris wasn't speaking at five, he would never do so. By the time he was seven, Chris had begun to produce words; at ten, he could speak in short sentences. Chris learned to match pictures of the American presidents to their names, and Jae made numerical games so that Chris could learn math and how to count money. When I first saw Chris's room, it was overflowing with learning materials: the beads and marbles he was using to learn to count were falling out of shoe bags; a cabinet held some five hundred homemade flash cards; musical instruments were everywhere; shelves upon shelves held bowls of everything from coins to plastic Sesame Street Sesame Street monsters. In addition, perhaps four hundred videotapes were piled around the room, crammed into shelves, wedged underneath and next to things, an Alexandrian library of cassettes. monsters. In addition, perhaps four hundred videotapes were piled around the room, crammed into shelves, wedged underneath and next to things, an Alexandrian library of cassettes.

When a new intern started, Jae would say, "Here's two hundred dollars. You're going to come into the next room, where we've hidden something. And you'll try and guess what it is and where it is." The person would come into a darkened room, and all the other interns would be screaming and clicking and making nonsensical remarks. The new intern would get more and more frustrated and would finally say, "I don't understand what you're doing! What do you want?" And Jae would say, "Come on, find it, and I'll give you two hundred dollars!" When the person finally walked out, Jae would explain, "That's what life is like for autistic children."

Bill took Jae's devotion as a challenge and took over negotiating with the state to pay for treatment. "The local schools people had been confronted by emotional parents who'd say, 'My son needs forty hours of therapy,' and they'd say, 'Sorry-you lose,'" Bill recalled. "I would say, 'Now, in say, 'Now, in Ethridge vs. Collins Ethridge vs. Collins...' They hated hated me. But I grew up in the heartland of Irish gangs in New York. I certainly wasn't afraid of a schoolteacher in Lancaster." If it could be established that what Bill and Jae were doing at home was more appropriate for Chris than what the school district was offering, the district had to underwrite the program. Bill came in with an annual budget: what materials cost; what workshops cost; what the interns cost. Meanwhile, the development of therapies had become a family project. Chris's sister, Jessie, would take two of some instrument-a triangle, say-play one under the table, and ask Chris to play the same one over it; Jae explained the mechanism of that training to Jessie. When the first district psychologist came to review the family's requests, he asked eight-year-old Jessie, "What are you doing?" She said, "Collecting sound discrimination data." The psychologist said to the district committee, "The Davises know more than I do. Just give them what they want." me. But I grew up in the heartland of Irish gangs in New York. I certainly wasn't afraid of a schoolteacher in Lancaster." If it could be established that what Bill and Jae were doing at home was more appropriate for Chris than what the school district was offering, the district had to underwrite the program. Bill came in with an annual budget: what materials cost; what workshops cost; what the interns cost. Meanwhile, the development of therapies had become a family project. Chris's sister, Jessie, would take two of some instrument-a triangle, say-play one under the table, and ask Chris to play the same one over it; Jae explained the mechanism of that training to Jessie. When the first district psychologist came to review the family's requests, he asked eight-year-old Jessie, "What are you doing?" She said, "Collecting sound discrimination data." The psychologist said to the district committee, "The Davises know more than I do. Just give them what they want."

Still, the Davises, who had no health insurance, had a lot to pay for on their own. Chris had gymnastics, speech classes, hospital assessments, and consultations with a variety of doctors who did not take Medicaid. "I was working four bartending jobs, bringing home sometimes twenty-five hundred dollars a week," Bill said. "But, I swear to God, we couldn't pay our rent. When things got really bad, I'd hold a bar fund-raiser: I'd solicit a baseball from the Phillies; I went to the Flyers and got hockey sticks. I'd sell it all at the bar and raise six thousand dollars at a clip."

Like many autistic people, Chris has intestinal issues. Going to the bathroom can be painful for him, and he tends to hold on for as long as possible. "So his movements build up, and then movements explode behind movements," Bill said. "He'll say, 'Bath,' and he'll hug me. I clean him and disinfect the room. My God, this is filthy. It's stacked with old movies, and he's stepping on them, and he just peed over there. It's horrible. But it's what works." The place felt at once squalid and love-imbued. Bill told me that for Jae, who had had a harsh childhood, the chance to raise her children in a perfect home had been a cherished dream. "For her to let her house go-it was a real decision," he said.

When Chris was nine, the Davises decided that it was time for him to enter the school system. The school district agreed to let Jae train his teachers. The one who would be in charge of his education came to their home the summer before Chris was to matriculate. "She was open and very willing to learn and had kindness to her. I knew I could work with her," Jae said. That autumn, Chris attended school in a classroom with two other boys, the teacher Jae had trained, and four assistant teachers.

Soon after Chris started school, Jae began to say she was tired. "She would get up at six a.m., go to bed at three a.m.," Bill said. "Always writing; always on the Internet; always calling; always traveling. So I was surprised when she started saying, 'Could you just take him?'" She finally went to a doctor and found that, at age forty-five, she had a malignant cervical tumor the size of a grapefruit that had metastasized to her lungs and spine; one of her kidneys had shut down; she had suffered a minor heart attack; and she had lost enough blood through internal bleeding to need an emergency five-hour transfusion.

When I met Jae, she had been given a few months to live. A nurse came to the house to administer the chemotherapy Jae hoped would eke out a little more time. Even without hair, and somewhat emaciated, she was beautiful, and she had a gentleness that contrasted with Bill's machismo. She had insisted that I visit despite her condition. "I'm so lucky," she said to me, "that Chris started school. He's ready to do things on his own. Bill will make sure he gets what he needs. I always saw what he saw, but Bill feels what he feels. I've done what I came to do." The closed-circuit television system she'd set up to monitor Chris's teachers was still in place, so she could watch what happened in his room upstairs without rising. "It's just been such a strange experience for me, everything going on at once, my dying, Chris going to school," Jae said. "I worry more about my daughter and husband than about Chris. Honestly, he's just a happy kid. But it's hard to get him to conceptualize emotions, so I'm struggling to help him understand that I won't be around."

Chris had become aggressive, mostly toward Bill, whom he kept biting and punching and head-butting. But he had brought a lot of his videos downstairs, and he started curling up with them and his mother in her hospital bed. I arrived to find Jae drugged and elegiac; Chris was demanding and noisy and kept hitting himself and other things. "Don't hit Daddy," Bill would say, smoothing Chris's irate brow with one hand and holding Jae's hand with the other. Then Chris suddenly said to Jae in his thick voice, "I love you," and lay his head down on her chest.

Ten days after I met her, on a quiet October afternoon, Jae died. She bequeathed her teaching materials to the universities where she had found help. "It won't do any good to write it all down," Bill said, "because the real thing of it is Jae herself, not anything that I could record." Shortly before Jae's death, the city of Lancaster gave her the Red Rose Award for her work. A few days later, the Intermediate Unit that had fought the Davises on their educational priorities announced the Jae Davis scholarships to pay for ten families a year to attend the National Conference on Autism. Franklin and Marshall College announced the Jae Davis Internship Program; Penn State announced the Jae Davis Parent Scholarship; the Organization for Autism Research set up the Jae Davis Memorial Award. Jae Davis Internship Program; Penn State announced the Jae Davis Parent Scholarship; the Organization for Autism Research set up the Jae Davis Memorial Award.

Bill soldiered through his grief. "Our marriage changed completely the day Chris was diagnosed," he said. "We very rarely had sex; we very rarely had a close or romantic moment. If we went out to dinner, which was once a year, we would talk about Chris. Things just replaced other things. If Chris never works or marries, who cares? Let Chris be Chris. Chris taught us everything. He taught us how to deal with him; how he learned; how to let him live his life. We drove to a spot the other night that his mother and he used to go to, and he just started to cry. And I know it was because of that. My son is not a puzzle. I know exactly what he is." Bill, who had always had a taste for tattoos, started inscribing Chris's disability on his body. Bill has the word autism autism emblazoned across his chest; an extremely large autism puzzle ribbon, the symbol of the Autism Society of America; and the symbol for Unlocking Autism: a emblazoned across his chest; an extremely large autism puzzle ribbon, the symbol of the Autism Society of America; and the symbol for Unlocking Autism: a U, U, an an A, A, and a key. and a key.

I fell out of touch with Bill for a little while. "Jae pushed Chris so hard, and when she died, he said, 'No school,'" Bill said when we met again. "I thought, 'Well, if what he really wants is to watch television all day, should we keep pushing him to do all these other things?'" Bill was charged for truancy; pushed over the edge by Jae's medical bills, the family became homeless and lived for a while on park benches in Lancaster. Eighteen months after Jae died, Chris was maturing. The smearing of feces had stopped. Chris had begun to understand that the world had other rules than his, and that he must bend to them. It was almost as though the coddling attention of his demanding mother was needed to bring him out into communication, while his father's harder exigencies were needed to help him see its purpose-as if his mother gave him language and his father made him use it.

I had always been skeptical of Bill's assertions about Chris's verbal abilities; he had demonstrated only occasional comprehension of a few dozen words and spoke mostly in nouns and memorized short phrases. During my last visit, I was astonished to find him typing complicated entries into a computer; while I sat there, he logged on to eBay and searched for videos. Chris actually knew many words, but did not show an inclination to use them to connect with other people. But his capacity for emotion had grown, too. When I walked in, he began flapping his hands and making high-pitched sounds; I thought that could just be alarm, but when I sat down on the sofa, he curled up next to me.

Temple Grandin once described herself as "an anthropologist on Mars," a description that the neurologist Oliver Sacks appropriated as the title for one of his books. But Chris was like a Martian in a roomful of anthropologists. "In case he feels everything," Bill said, "I talk to him about it all and I love him totally and completely. Just in case." Is it neurotypical prejudice to posit that human nature entails an aspirational longing to be loved, applauded, accepted? the title for one of his books. But Chris was like a Martian in a roomful of anthropologists. "In case he feels everything," Bill said, "I talk to him about it all and I love him totally and completely. Just in case." Is it neurotypical prejudice to posit that human nature entails an aspirational longing to be loved, applauded, accepted?

Two diametrically opposite fictions contribute to a single set of problems. The first comes from the autism parents' literature of miracles. In its most extreme form, it describes beautiful boys and girls emerging from their affliction as if it were a passing winter frost, and, after wild parental heroics, dancing off into springtime fields of violets, fully verbal, glowing with the fresh ecstasy of unself-conscious charm. Such narratives of false hope eviscerate families who are struggling with the diagnosis. The other plotline is that the child does not get better, but the parents grow enough to celebrate him rather than seek to improve him and are fully content with that shift. This whitewashes difficulties that many families face and can obfuscate autism's authentic deficits. While the lives of many people who have autism remain somewhat inscrutable, the lives of people whose children have autism are mostly avowedly hard-some, excruciatingly so. Social prejudice aggravates the difficulty, but it is nave to propose that it's all social prejudice; having a child who does not express love in a comprehensible way is devastating, and having a child who is awake all night, who requires constant supervision, and who screams and tantrums but cannot communicate the reasons for or the nature of his upset-these experiences are confusing, overwhelming, exhausting, unrewarding. The problem can be mitigated by some combination of treatment and acceptance, specific to each case. It is important not to get carried away by either the impulse only to treat or the impulse only to accept.

The world of disability has seen a great deal of filicide. Those who kill their autistic children usually claim that they wanted to spare those children suffering, but anyone who questions the autism rights movement has only to look at these stories to see how urgent a cause it is to argue for the legitimacy of autistic lives.

In 1996, Charles-Antoine Blais, age six, was killed by his mother, who did no jail time but served one year in a halfway house and then was appointed as a public representative by Montreal's Societe de l'autisme. In 1997, Casey Albury, age seventeen, was strangled by her mother with a bathrobe cord, after refusing to jump off a bridge. Her mother said to the police, "She was a misfit. People were scared of her because she was different. I wish it could have been quicker. I'd wanted to kill her for a long time." She received a sentence of eighteen months for manslaughter. In 1998, Pierre Pasquiou was drowned by his mother, who was given a three-year suspended sentence. In 1999, James Joseph Cummings Jr., at the age of forty-six, was stabbed to death by his father inside the residential facility where he lived. Cummings Sr. was sentenced to five years in prison. That same year, Daniel Leubner, age thirteen, was burned alive by his mother, who was sentenced to six years in prison. In 2001, Gabriel Britt, age six, was suffocated by his father, who dumped his body in a lake and then received a four-year sentence for pleading guilty to a lesser crime. Also in 2001, Jadwiga Miskiewicz strangled her thirteen-year-old son, Johnny Churchi, and was sentenced to time in a psychiatric hospital; a medical examiner said that she had "'a rigorous standard of excellence' she couldn't live up to anymore." In 2003, Angelica Auriemma, age twenty, was drowned by her mother, Ioanna, who had first attempted to electrocute her. Angelica's mother said, "I worried obsessively"; she served three years. Also that year, Terrance Cottrell died of asphyxiation when his mother and other churchgoers submitted him to an exorcism. A neighbor described the mother as explaining how "they held him down for almost two hours. He couldn't hardly breathe. Then she said the devil started to speak through Junior, though he can't really speak, saying, 'Kill me, take me.' She said the church told her it was the only way to heal him." She was not prosecuted; the minister who had led the exorcism was sentenced to two and a half years in prison and fined $1,200. In 2003, Daniela Dawes strangled her ten-year-old son, Jason, and was given five years of probation. Her grief-stricken husband testified, "Until that day she was the best mother anyone could want." In 2005, Patrick Markcrow, age thirty-six, was suffocated by his mother, who received a two-year suspended sentence; that same year, Jan Naylor shot her twenty-seven-year-old autistic daughter, Sarah, then set the house on fire, killing herself as well; the wanted to kill her for a long time." She received a sentence of eighteen months for manslaughter. In 1998, Pierre Pasquiou was drowned by his mother, who was given a three-year suspended sentence. In 1999, James Joseph Cummings Jr., at the age of forty-six, was stabbed to death by his father inside the residential facility where he lived. Cummings Sr. was sentenced to five years in prison. That same year, Daniel Leubner, age thirteen, was burned alive by his mother, who was sentenced to six years in prison. In 2001, Gabriel Britt, age six, was suffocated by his father, who dumped his body in a lake and then received a four-year sentence for pleading guilty to a lesser crime. Also in 2001, Jadwiga Miskiewicz strangled her thirteen-year-old son, Johnny Churchi, and was sentenced to time in a psychiatric hospital; a medical examiner said that she had "'a rigorous standard of excellence' she couldn't live up to anymore." In 2003, Angelica Auriemma, age twenty, was drowned by her mother, Ioanna, who had first attempted to electrocute her. Angelica's mother said, "I worried obsessively"; she served three years. Also that year, Terrance Cottrell died of asphyxiation when his mother and other churchgoers submitted him to an exorcism. A neighbor described the mother as explaining how "they held him down for almost two hours. He couldn't hardly breathe. Then she said the devil started to speak through Junior, though he can't really speak, saying, 'Kill me, take me.' She said the church told her it was the only way to heal him." She was not prosecuted; the minister who had led the exorcism was sentenced to two and a half years in prison and fined $1,200. In 2003, Daniela Dawes strangled her ten-year-old son, Jason, and was given five years of probation. Her grief-stricken husband testified, "Until that day she was the best mother anyone could want." In 2005, Patrick Markcrow, age thirty-six, was suffocated by his mother, who received a two-year suspended sentence; that same year, Jan Naylor shot her twenty-seven-year-old autistic daughter, Sarah, then set the house on fire, killing herself as well; the Cincinnati Enquirer Cincinnati Enquirer wrote that they both "died of hopelessness." In 2006, Christopher DeGroot was burned to death when his parents locked him in the house and set it on fire. Each of them was sentenced to six months in jail. In 2006, Jose Stable slit the throat of his son, Ulysses. He called the police and said, "I just couldn't take it anymore." Jose Stable served a three-and-a-half-year sentence. In 2007, Diane Marsh killed her son, Brandon Williams, age five; the autopsy said he had died of multiple skull fractures and an overdose of Tylenol PM tablets; his legs were covered in burn scars because his mother used to discipline him by dipping him into scalding water. She was sentenced to ten years. In 2008, Jacob Grabe was shot by his father, who pleaded not guilty by reason of insanity. wrote that they both "died of hopelessness." In 2006, Christopher DeGroot was burned to death when his parents locked him in the house and set it on fire. Each of them was sentenced to six months in jail. In 2006, Jose Stable slit the throat of his son, Ulysses. He called the police and said, "I just couldn't take it anymore." Jose Stable served a three-and-a-half-year sentence. In 2007, Diane Marsh killed her son, Brandon Williams, age five; the autopsy said he had died of multiple skull fractures and an overdose of Tylenol PM tablets; his legs were covered in burn scars because his mother used to discipline him by dipping him into scalding water. She was sentenced to ten years. In 2008, Jacob Grabe was shot by his father, who pleaded not guilty by reason of insanity.

As the vast majority of these sentences suggest, the habit of the courts has been to treat filicide as an understandable, if unfortunate, result of the strains of raising an autistic child. Sentences are light, and both the courtroom and the press frequently accept the murderer's profession of altruistic motives. After Zvia Lev poisoned her sixteen-year-old autistic son, she said, "I just could not see my boy grow up slowly into a brainless man." The judge, encouraging a lenient sentence, said, "Her true punishment is having to live under the shadow of her crime, the memory of which will pursue her as long as she lives." About the murder of Charles Blais, the president of the Montreal Autism Society said that the murder was "unacceptable but understandable." Laura Slatkin said, "We've spoken to many families who say, 'We all share that hidden, dark thought.'" In an op-ed in the New York Times, New York Times, Cammie McGovern, herself the mother of an autistic child, wrote, "In mythologizing recovery, I fear we've set an impossibly high bar that's left the parents of a half-million autistic children feeling like failures." Autistic children can make great strides, McGovern continues, but to expect complete recovery-"the person your child might have been without autism"-is to enter "a dangerous emotional landscape," one with scope for murder. Cammie McGovern, herself the mother of an autistic child, wrote, "In mythologizing recovery, I fear we've set an impossibly high bar that's left the parents of a half-million autistic children feeling like failures." Autistic children can make great strides, McGovern continues, but to expect complete recovery-"the person your child might have been without autism"-is to enter "a dangerous emotional landscape," one with scope for murder.

Yet altruism altruism is a problematic word to describe acts that leave dead children in their wake. A quantitative study has shown that almost half of parents who kill a disabled child do no jail time at all. "While you could kill a person who has a cold, and that would end their suffering due to their cold, a more appropriate method is to provide them medical assistance, rest, plenty of fluids, and compassion," Joel Smith, an autistic adult, has written on his blog. "When a drunk driver, who does not plan the result, is sent to jail for life after killing an innocent child, surely a parent who plans a murder of her child should also get the same sentence." is a problematic word to describe acts that leave dead children in their wake. A quantitative study has shown that almost half of parents who kill a disabled child do no jail time at all. "While you could kill a person who has a cold, and that would end their suffering due to their cold, a more appropriate method is to provide them medical assistance, rest, plenty of fluids, and compassion," Joel Smith, an autistic adult, has written on his blog. "When a drunk driver, who does not plan the result, is sent to jail for life after killing an innocent child, surely a parent who plans a murder of her child should also get the same sentence."

The dangers of seeing disability entirely as illness and not at all as identity are starkly evident in the explanation Dr. Karen McCarron gave for suffocating her three-year-old daughter, Katie, in 2008. She said, "Autism left me hollow. Maybe I could fix her this way, and in heaven she would be complete." One of McCarron's friends said, "Karen never took a night off. She read every book. She was trying so hard." Katie McCarron's paternal grandfather has responded to such rationalizations with indignation. "Some newspapers have reported that this was done to end Katie's pain; let me assure you that Katie was not in pain," he wrote. "She was a beautiful, precious and happy little girl. Each day she was showered with love and returned that love with hugs, kisses, and laughter. I am positively revolted when I read quotes that hint at condoning the taking of my granddaughter's life." On another occasion, he said, "If these people are 'advocates' for people with autism, I can't imagine what the 'opponents' must be like." quotes that hint at condoning the taking of my granddaughter's life." On another occasion, he said, "If these people are 'advocates' for people with autism, I can't imagine what the 'opponents' must be like."

Stephen Drake, research analyst for the organization Not Dead Yet, wrote, "On June 9, the Chicago Tribune Chicago Tribune published an article about the McCarron case. The title was 'Daughter's murder puts focus on toll of autism,' making the thrust of the article all too clear. More space was devoted to sympathetic comments about Karen McCarron and negative comments about autism itself than to descriptions of the victim or comments from deeply grieving family members." Dave Reynolds, editor of published an article about the McCarron case. The title was 'Daughter's murder puts focus on toll of autism,' making the thrust of the article all too clear. More space was devoted to sympathetic comments about Karen McCarron and negative comments about autism itself than to descriptions of the victim or comments from deeply grieving family members." Dave Reynolds, editor of Inclusion Daily Express, Inclusion Daily Express, wrote of such coverage, "In every case, neighbors and family members described the murderer as a lovely, devoted mother. In each case the murderer was portrayed as a desperate victim of her child's disability and a victim of a social service system that failed to provide enough of the right supports." Reynolds complains that these murders are exploited to secure subsidies for treatment programs and worries that this "reinforces the idea that these children are horrible burdens to their parents and to society. In no way can anyone justify murdering a child, nor sympathize with the killer. Each of these women had infinite alternatives to murder." wrote of such coverage, "In every case, neighbors and family members described the murderer as a lovely, devoted mother. In each case the murderer was portrayed as a desperate victim of her child's disability and a victim of a social service system that failed to provide enough of the right supports." Reynolds complains that these murders are exploited to secure subsidies for treatment programs and worries that this "reinforces the idea that these children are horrible burdens to their parents and to society. In no way can anyone justify murdering a child, nor sympathize with the killer. Each of these women had infinite alternatives to murder."

Others would vehemently disagree that the alternatives available to parents coping with autistic children are infinite; in fact, many parents who eventually turn on their children have first struggled to secure placements that eluded them. Heidi Shelton, who attempted unsuccessfully to kill herself and her five-year-old son, said, "I can't let Zach live in this world where he is constantly rejected by everyone, including his family, education system, etc." John Victor Cronin, who attempted but failed to kill his twenty-six-year-old son, his wife, and himself, was able to get his son a placement only after his trial. His wife said, "There's nowhere to go until people are almost killed; then they've got a place for people like Richard." If we feel some measure of responsibility toward these parents-and the outpouring of sympathy that commonly greets these murders suggests that we do-we would serve them and their children far better with more endgame strategies. We need respite care, and free and satisfactory residential placements; we need positive narratives of autism that free parents from the compulsion to eliminate the syndrome, even at the cost of eliminating the child.

Parents of autistic children are often sleep-deprived. They are frequently impoverished by the cost of care. They are overwhelmed by the unrelenting needs of children who often require constant supervision. They may be divorced and isolated. They may spend endless hours fighting their insurance and health providers and the local education authority that determines what services their child will get. They may forfeit their jobs because they miss so many days to deal with crises; they often have poor relationships with their neighbors because their children destroy property or are violent. Stress leads people to extreme acts; extreme stress leads people beyond our most profound social taboo: the slaughter of one's own child. Some claim to kill their autistic children out of love, and some acknowledge hate or anger. Debra L. Whitson, who attempted to kill her son, told police by way of explanation, "I waited eleven years to hear him say, 'I love you, Mom.'" Passion is confusing, and most of these parents act out of emotion so overpowering that to identify it as either love or hate is to reduce it. They themselves do not know what they are feeling; they know only how much they feel it. authority that determines what services their child will get. They may forfeit their jobs because they miss so many days to deal with crises; they often have poor relationships with their neighbors because their children destroy property or are violent. Stress leads people to extreme acts; extreme stress leads people beyond our most profound social taboo: the slaughter of one's own child. Some claim to kill their autistic children out of love, and some acknowledge hate or anger. Debra L. Whitson, who attempted to kill her son, told police by way of explanation, "I waited eleven years to hear him say, 'I love you, Mom.'" Passion is confusing, and most of these parents act out of emotion so overpowering that to identify it as either love or hate is to reduce it. They themselves do not know what they are feeling; they know only how much they feel it.

More than half of the children murdered in the United States are killed by their parents, and about half of those parents claim to have acted altruistically. Societal acceptance of that label, however, has been shown to have a toxic effect. Criminologists consistently report that the use of the word altruism altruism by bioethicists increases not only the number of filicides but also the frequency of abuse, disinhibiting parents who are already inclined toward violence. Copycat episodes commonly follow high-profile cases in which the altruism motive is endorsed. FBI profilers have argued that in many such killings the real motive is the need for power and control. Courtroom leniency sends a message to the society at large, to other parents, and to people with autism that autistic lives are less valuable than other lives. This line of reasoning comes perilously close to eugenics. by bioethicists increases not only the number of filicides but also the frequency of abuse, disinhibiting parents who are already inclined toward violence. Copycat episodes commonly follow high-profile cases in which the altruism motive is endorsed. FBI profilers have argued that in many such killings the real motive is the need for power and control. Courtroom leniency sends a message to the society at large, to other parents, and to people with autism that autistic lives are less valuable than other lives. This line of reasoning comes perilously close to eugenics.

VI

Schizophrenia

The trauma of Down syndrome is that it is present prenatally and can therefore undermine the early stages of bonding. The challenge of autism is that it sets in or is detected in the toddler years, and so transfigures the child to whom parents have already bonded. The shock of schizophrenia is that it manifests in late adolescence or early adulthood, and parents must accept that the child they have known and loved for more than a decade may be irrevocably lost, even as that child looks much the same as ever. Initially, parents almost universally believe that schizophrenia is invasive, an added layer masking their beloved child, who must somehow be liberated from its temporary conquest. The more likely reality is that schizophrenia, like Alzheimer's, is an illness not of accrual but of replacement and deletion; rather than obscuring the previously known person, this disease to some degree eliminates that person. Yet vestiges persist, most notably in the doggedness of personal history, for the person with schizophrenia will recall events of a childhood in which mental illness played no apparent role. He will tell his parents the things they did right and tried to do right, as well as any history of trauma. He will know his cousins by name and will preserve certain skills: a mean backhand at tennis, perhaps, or the ability to raise a single eyebrow in surprise or disdain. He may sustain other continuities-a sense of humor, a dislike of broccoli, a love of autumn sunlight, a preference for rollerball pens. He may retain his most basic aspects of character, including kindness.

The betrayal of schizophrenia is its irrational juxtaposition of things that vanish and things that don't. Schizophrenia can take away the ability to connect to or love or trust another person, the full use of rational intelligence, the capacity to function in any professional context, the basic faculty of physical self-care, and large areas of self-awareness and analytic clarity. Most famously, the schizophrenic disappears into an alternative world of voices that he erroneously perceives to be external; these internally generated relationships become far more real and important than any interaction with the authentically outside world. The voices are usually cruel and often encourage bizarre and inappropriate behavior. The person who hears them is commonly terrified and almost always paranoid. Sometimes, the hallucinations are visual and olfactory as well and make a world full of actual threats into a writhing hell of inescapable terrorization. Though many schizophrenics become curiously attached to their delusions, the fading of the nondelusional world puts them in loneliness beyond all reckoning, a fixed residence on a noxious private planet they can never leave, and where they can receive no visitors. Between 5 and 13 percent of people with schizophrenia commit suicide. In some sense, though, that is the least of it; a woman whose schizophrenic brother committed suicide said, "Eventually, Mama got over Roger's death, but she never got over his life." alternative world of voices that he erroneously perceives to be external; these internally generated relationships become far more real and important than any interaction with the authentically outside world. The voices are usually cruel and often encourage bizarre and inappropriate behavior. The person who hears them is commonly terrified and almost always paranoid. Sometimes, the hallucinations are visual and olfactory as well and make a world full of actual threats into a writhing hell of inescapable terrorization. Though many schizophrenics become curiously attached to their delusions, the fading of the nondelusional world puts them in loneliness beyond all reckoning, a fixed residence on a noxious private planet they can never leave, and where they can receive no visitors. Between 5 and 13 percent of people with schizophrenia commit suicide. In some sense, though, that is the least of it; a woman whose schizophrenic brother committed suicide said, "Eventually, Mama got over Roger's death, but she never got over his life."

Few things could be worse than perceiving your dreams as true. We all know that lovely relief of stretching out to welcome a new day, free of shadow horrors that came in slumber. Psychosis is a gross disturbance in an individual's ability to distinguish self from reality. For schizophrenics, the membrane between imagination and reality is so porous that having an idea and having an experience are not particularly different. In the earlier stages of illness, schizophrenics often have symptoms of depression, because psychosis itself is distressing and because of the desperate nature of schizophrenic thought. This is the time of greatest suicide risk. In later stages, emotional capacity altogether is reduced, and people may seem vacant and emotionless.

Interviewing schizophrenics, I was struck by the way those deep in the disease seemed not to feel self-pity, which contrasted sharply with my experience of people with depression and other psychiatric disorders-a frequently whiny group to which I myself belong. People in the early stages were horrified and sad, but those who had been sick a long time were not. They complained about particular delusions or felt guilty not to be functioning better, but there was surprisingly little railing at the disease itself. Many had once been headed for wonderful lives, but the woman who had been a great beauty seemed, unlike her parents, not to think about the adventures in love she would have had; a sweet-natured fellow who had been wildly popular in high school could not tell me, as his parents could, how much pleasure a lifetime of friendships might have given him; a man who excelled at Harvard at the time of his first psychotic break never talked, as his parents did, about the career he had so narrowly missed. It seemed that illness had cut these schizophrenics off from those lives so entirely that they were hardly conscious of them. They had stoic grace in relation to their illness, and I was consistently moved by it. hardly conscious of them. They had stoic grace in relation to their illness, and I was consistently moved by it.

The first time I met Harry Watson, he undermined my perceptions of schizophrenia. Impossibly good-looking at age thirty-eight, he had such a pleasant and open expression and such an easy and amusing way of speaking that I would not have known anything was wrong if I hadn't been told ahead of time. He was at a party thrown by his accomplished half sister Pamela and had come with his naturally elegant, casually intelligent mother, Kitty, and the three of them seemed like they could have been extras in The Philadelphia Story The Philadelphia Story. "I think he always hopes it will be more fun than it turns out to be for him," Kitty said to me later. "He starts sweating a lot. He could barely get out of bed the next day."

Pamela and Harry share Kitty as their mother; Harry has two other half sisters via his father, Bill. The only boy and the youngest of the four, Harry was born in 1969 in California, much indulged and doted on. "He was a wonderful baseball player," Kitty said. "When he was about ten, he said the coach had asked him to be pitcher; Harry said, 'I don't think I could handle that kind of pressure.' Doesn't that sound strange from a ten-year-old? He has told me that even at that age, he felt like there was something wrong." Pamela, a novelist and journalist, said, "You hear this story a lot, but he was a golden boy. He was a great athlete, charismatic, the one everyone copied. Then my mother and his father, my stepfather, divorced when he was twelve, the same year I left for college. The message he had heard all along from his father was that you don't show weakness. Instead of admitting that he felt weird, Harry just hid it." Until he finished high school, Harry still had friends and seemed like a normal teenager. "He presents as much better than he is, so even since his diagnosis, his therapists have picked up much less than they should have," Kitty said. "He still thinks that if he acts like he's normal, he'll be treated more normally by the world. All it means is that he doesn't get as much help as he needs."

"We had no idea what was going on for a long time, so we didn't take steps to find him proper treatment," Pamela said. "The results were catastrophic. He was in the hands of this greedy, incompetent, unethical shrink my stepfather had found, and none of us realized how bad that situation was. It broke Harry's heart to find that this guy was a charlatan-something he could see only many years and hospitalizations down the road-and he was never able to trust another therapist that way." Recognizing psychosis can be a gradual project. "For years, I would instantly forget things Harry said and did that were just not right," Pamela said. "The year I was twenty-four and he was eighteen, he became very depressed and secretive, and my mother convinced me to come home for Christmas to talk to him. We shut the door to his room and didn't emerge for six hours. He told me that everyone thought he was gay. He was convinced that his girlfriend thought he was gay, that all of his friends thought he was gay, that my mother and his father thought he was gay. I said, 'That's ridiculous! No one thinks you're gay.' That was a revelation, and he seemed to be freed, and I felt very good about having helped him. Taking a step back, that was a very complicated, prolonged delusion. He really needed serious treatment." he became very depressed and secretive, and my mother convinced me to come home for Christmas to talk to him. We shut the door to his room and didn't emerge for six hours. He told me that everyone thought he was gay. He was convinced that his girlfriend thought he was gay, that all of his friends thought he was gay, that my mother and his father thought he was gay. I said, 'That's ridiculous! No one thinks you're gay.' That was a revelation, and he seemed to be freed, and I felt very good about having helped him. Taking a step back, that was a very complicated, prolonged delusion. He really needed serious treatment."

Harry enrolled in Rollins College and majored in philosophy and studied psychology-"clearly trying to understand what was happening to him," Kitty said. The next Christmas, Pamela and Harry went to Palm Springs to join Harry's father and his other children. "Harry was incredibly hostile," Pamela said. "One night, he suddenly announced that he had taken acid with one of my stepsisters. He discovered on this LSD trip that his brain always is that way. That's, basically, a declaration of schizophrenia." Still, despite little episodes of weirdness through his college graduation in 1992, Harry seemed to be holding on.

Four years after graduation, he became full-on psychotic for the first time, terrified of his own thoughts; he went into Langley Porter Psychiatric Hospital in San Francisco in the spring of 1996. "We started playing Scrabble, because it's hard to know what to talk about with someone that crazy," Kitty said. "He was pointing to a van in the street, saying that's where the FBI had their equipment. He thought the nurses were trying to poison him, and he didn't want to take medication. I went to his apartment after he was hospitalized and it was in complete chaos, like a reflection of the inside of his head."

Harry was in Langley Porter for ten days. When he came out, he found a job in computer programming. "It went well for a while, and then he was saying his apartment was bugged," Kitty said. "He had stopped taking one of his medications. I said, 'Why don't you come over here for the night?' He said, 'Your house is bugged, too, I'll show you where the transmitters are.' So he takes me down to the laundry room and points to where he says the stuff is. I hauled him off to Langley Porter again, and this happened on and off for years. Within three days of his leaving the hospital each time, you could feel the self-deception growing thicker and thicker." The war was being lost. "Unfortunately, by then, the voices had a grip on him," Pamela said. "How can you compete when they're piping in there twenty-four hours a day? It is so critical so critical that parents of kids with mental illness see it early. If we had realized when he was fifteen that something was wrong, who knows what we could have done? It wasn't until he was thirty that he that parents of kids with mental illness see it early. If we had realized when he was fifteen that something was wrong, who knows what we could have done? It wasn't until he was thirty that he was finally helpless enough, freaked-out enough, convinced enough, that he was back in our hands for treatment." was finally helpless enough, freaked-out enough, convinced enough, that he was back in our hands for treatment."

Kitty experienced that year as a descent into deepening hell. "His father had a place in Napa," she said. "Harry went there for a weekend in 1997 and never left. After almost a year, I showed up one day, and when he saw me, he screamed, 'What the hell are you doing here?' like he was possessed by some demon. I said, 'Your dad and I feel that you need to come back to the city, start seeing a doctor regularly, live at home with me, and get on medication.' He said, 'I'm not going to.' I said, 'If you don't, we're throwing you out and you're going to be on the streets.' I was terrified that he would take me up on that, and I had found a private eye to follow him around, so that nothing bad would happen to him. A private eye to shadow someone with a paranoid delusion that he was being tracked by the FBI. He screamed how he hated me. Forty-eight hours later he moved home." Pamela remembered, "Harry also has a drinking problem, and in Napa he just drank. I mean, bottles of tequila, until he blacked out. It's amazing he's alive. Then drinking would make him incredibly depressed. That's when he would drive to the Golden Gate Bridge and sometimes stand right on it, thinking about whether to jump. He says he came very close once. But he's not a risk-taker, so he's less suicidal than you would expect."