This article argues that the meaning of the word ‘autism’ experienced a radical shift in the early 1960s in Britain which was contemporaneous with a growth in epidemiological and statistical studies in child psychiatry. The first part of the article explores how ‘autism’ was used as a category to describe hallucinations and unconscious fantasy life in infants through the work of significant child psychologists and psychoanalysts such as Jean Piaget, Lauretta Bender, Leo Kanner and Elwyn James Anthony. Theories of autism were then associated both with schizophrenia in adults and with psychoanalytic styles of reasoning. The closure of institutions for ‘mental defectives’ and the growth in speech therapy services in the 1960s and 1970s encouraged new models for understanding autism in infants and children. The second half of the article explores how researchers such as Victor Lotter and Michael Rutter used the category of autism to reconceptualize psychological development in infants and children via epidemiological studies. These historical changes have influenced the form and function of later research into autism and related conditions.

The metamorphosis of autism 2 child prevalence rate of autistic spectrum disorder could be as high as 157 per 10,000, or 1 in every 64 children. 2 Yet it was not always like this. Just forty years ago, hardly anyone had heard of autism. The condition of autism was thought to affect just 4-5 per 10,000 people and was thus considered extremely rare. There were some psychological specialists who wrote on the subject of autism in the 1960s, but they largely regarded 'autism' as a normal developmental stage in the formation of human relationships, characterised by hallucinatory and imaginary thinking, which they thought some children were never able to overcome. This is not the 'autism', or autistic spectrum, that we know today. In fact, an important part of this book covers the major transition, indeed complete reversal, in the meaning of autism that occurred in the late 1960s and 1970s, and was fully embraced by the 1990s. In this book, I argue that it was this reversal in the meaning of autism that enabled the expansion of the category; the growth in diagnoses; the expansion of health, educational and social services for individuals diagnosed with autism; and the general cultural phenomenon that autism has become today.Since the late 1990s, there has been a growing interest in why autism has become so prevalent in the UK and elsewhere in the world. The sociologist Gil Eyal has written convincingly of the impact of major changes in the institutional care of children diagnosed with 'mental retardation' that took place in the 1960s in many parts of the USA and Europe. He has argued that deinstitutionalisation provoked new questions about children's psychological development and enabled the formation of new networks of expertise uniting psychologists, psychiatrists, therapists and parents, thereby expanding the territory where autism could be discussed and increasing its prevalence. 3 In 2006, the autism researcher Paul Shattuck used data on the enrolment of children in special education programmes across the USA from 1994 to 2003, demonstrating that whilst more were diagnosed with autism, fewer were diagnosed with 'mental retardation' and 'learning disability' . In fact, the category of 'developmental delay' had also increased somewhat during that period, yet no one had thought to interrogate the 'epidemic' of 'developmental delay' . 4 Autism researchers whose working lives have overseen these transitions, such as Michael Rutter, have also argued that changes in the way that children have been assessed and treated for developmental abnormalities of all kinds have led to increases in 8The metamorphosis of autism 8 the growth of neoliberal economic models. This book tracks these significant changes in approaches to society, government and political and economic life, pointing out the importance of theories of child development to shaping ideas about social life and individuality. It looks in depth at how 'social development' in children has been described, formulated and understood, and how its antithesis has also bee...

When opened as a post-graduate teaching and research hospital in 1923, the Maudsley made virtually no provision for the treatment of children. Yet its children's department saw sustained growth during the interwar period. This expansion is explored in relation to novel behaviourist hypotheses and the forging of formal links with local government and charitable bodies. The recruitment of psychologists, educators and specialist social workers fostered a multidisciplinary approach through case conferences. This development would structure the theoretical origins of child psychiatry, in particular influencing the role and interpretation of psychoanalytic theory within it. The theoretical orientation of child psychiatry and the practical treatment of children represented an area of dynamic change and innovation at a time when adult psychiatry struggled to discover effective treatments or achieve breakthroughs in causal understanding.

The use of organ extracts to treat psychiatric disorder in the interwar period is an episode in the history of psychiatry which has largely been forgotten. An analysis of case-notes from The Maudsley Hospital from the period 1923-1938 shows that the prescription of extracts taken from animal testes, ovaries, thyroids, and other organs was widespread within this London Hospital. This article explores the way in which Maudsley doctors justified these treatments by tying together psychological theories of the unconscious with experimental data drawn from laboratory studies of human organs. It explores the logic behind these treatments and examines beliefs about their efficacy. The connection between this historical episode and current research in endocrinology and psychology is explored.

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