Monday, 24 May 2010

Dr Andrew Wakefield, 'autism' and CE

Lessons to learn

Today came the British Medical Association's long-expected judgement on Dr Wakefield, he of MMR vaccine and 'autism' fame. He has been struck off the register of the British Medial Association, which means that he can no longer practise medicine in the United Kingdom.

So what does this say to the world of Conductive Education? Two things, one structural to being 'professionals' (to which conductors aspire) and the other substantive to the very nature of disability and how it is understood (which afflicts CE around the world).

The doctors' profession

Dr Wakefield's name has been struck of the register of the British Medical Association. This is an association established and run by doctors themselves (at their own not inconsiderable personal expense) and, by long-standing arrangement with government, the BMA has the monopoly on the registration of doctors.

It is of course a national organisation. Other countries have their own registers, maintained through whatever arrangements have been developed, each according to its own.

Conductors still may be heard complaining that there are no 'international recognition' of their qualifications, no 'internationally accepted' professional standards. The doctors do not have such a thing, nor do the teachers, nor does any analogous trade. To wish otherwise for conductors is to mistake the nature of 'professionalism'.

Striking off Dr Wakefield's name means taking his name off a list. For this there must be a list to take it off, and safeguards about who is admitted to this list, to meet publicly available criteria, and who remains upon it. The list itself has to be publicly available and there have to be sanctions to encourage conformity with the expected standards. People have to be able to complain, their complaints have to be properly investigated and, if there is a problem, then there has to be due process to make sure that justice is done and seen to be done.

Codes of practice and ethics, professional codes are all very well but they are meaningful only of they exist as part of a complex public system to ensure their enforcement.. Otherwise,words, just words...

The doctors' error

The business that brought down Dr Wakefield stems back to a paper that he and colleagues published in 2002. The actually study has been analysed and re-analysed by the world's media and now by the BMA, and its bones picked clean of all flesh then scattered to the winds. Read about it, in any language if you can bear to. The original article was published in the Lancet and is available on line – at a cost. Here, however, is a cover version (I know that this is the wrong expression but I cannot recall the correct one):

The word 'autism' is a strange and powerful ju-ju that brings about a widespread suspension of disbelief in people who ought to know better. I have seen and heard this story chewed over for eight years now, but people just do not seem to see a fundamental question behind all the high-sounding talk of 'science' and 'ethics'.

Much ink has been spilled over the study population that Dr Wakefield and his colleagues reported upon,how it was found and how it was treated. My question is 'Who are they?' or, more specifically, 'What do they have in common to justify this investigation and all the attention lavished upon their 'autism'?'
  • 12 children... with a history of a pervasive developmental disorder ... Neurological and psychiatric assessments were done by consultant staff  with HMS-4 criteria.
And what is 'HMS-4'? I'm puzzled here but its is clearly referenced clearly to the current (fourth) edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 1994, commonly referred to as 'DSM-IV.' In this, the diagnosis of autism requires that at least six developmental and behavioural characteristics are apparent. This is presumably the basis for describing nine of these dozen children as having in common 'behavioural disorders included autism' – what the Wakefield et al. call 'neuropsychiatric dysfunction'.

And if you want to check on how a 'diagnosis' of autism is arrived at under DSM-IV, go see for yourself:

Some science!

The doctors' error, not just these doctors', is to think that such classification, followed by the leap into diagnosis of a supposed 'neuropsychiatric dysfunction', is sufficient basis for a programme of scientific investigation. The mental and behavioural are unproblematically medicalised – and no questions are raised. Whatever happened to Thomas Szasz! In the twenty-first century is medical imperialism of this kind really an acceptable 'ethical' stance?

If anything, the hegemony of the unquestioned assumptions of fundamentally biological determination of developmental disorder has been strengthened by the long fuss surrounding l'affaire Wakefield. No wonder Scope offers such a muddled course on brain and behaviour (this site, yesterday) – without a dynamic, systemic, developmental understanding of disability how could it do anything but? Classification systems are not a solution, and may indeed bolster the problem

And Conductive Education is swept along in the rush.

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