What is Asperger`s Anyway ?
Were this personality type promoted as schizophrenia without psychosis, few parents or affected individuals would ever seek diagnosis, yet the history of the emergence of this social construct clearly demonstrates its origins in psychiatry. In little more than a decade, Asperger`s has become so instilled in the public mind in Anglo-Saxon countries that journalists and playwrights may use it as a byword for social ineptitude or mindblindness. Social workers, teachers, parents and psychologists have contributed to a stereotyped view of this condition. It may refer to a form of mad professor syndrome associated with eccentric habits and incessant lecturing on some niche subject, to extreme social anxiety or to emotional immaturity. Ironically the AS-diagnosed may be considered both extrovert, when lecturing others, and introvert when isolating themselves from social gatherings. These diagnostic inconsistencies have led to the co-diagnosis of more categories such as Semantic Pragmatic Disorder (mad professor syndrome), Social Anxiety Disorder (shyness), Tourettes, Dyspraxia and ADHD. The best definition in support of the orthodox extended Autistic Spectrum Theory concerns purported deficits in the Theory of Mind module and thus an inability to instinctively empathise with others. We cannot deny that many AS-diagnosed individuals, as they are known in the psychiatric literature, seem exceedingly wrapped up in their own micro-worlds and have considerable problems interacting with peers at school, work or in the neighbourhood, often falling victim to bullying and deliberate alienation. The Asperger`s label purportedly provides hope that all this perceived suffering is not the fault of the affected individual, his parents or even necessarily of his peers, but of a lack of awareness of the individual`s neurological difference and society`s failure to accommodate the other-brained. Thus not only mind blindness is equated with physiological handicaps, some see neurological diversity as worthy of same equal rights treatment or positive discrimination as applied to other disadvantaged sections of the community such as women or ethno-racial minorities. However, this hope comes at a considerable price, that of delegating control of one`s own life to external intermediaries. After learning that normal people often bend the truth to avoid offence to others, but also to gain greater social acceptance and personal advantage over others, we are expected to place our trust in nice neurotypicals who have our best interests at heart. As Asperger`s individuals allegedly lack presentational and negotiating skills, they are naturally excluded from representing themselves except under the guidance of professionals and activists in the growing autism sector.
Three Marketing Pitches
The autism sector presents ASDs in three divergent ways, depending on the audience.
- When addressing affected individuals the literature emphasises the positives of neurological difference and the need for differentiation from mainstream neurologically typical society. Problems are analysed in terms of aspies’ alleged deficits in emotional intelligence, a concept as dubious as categorising people based on intelligence quotient.
- When addressing parents and teachers, both positives and negatives are highlighted, but usually in terms of people management and their responsibility to treat their aspie children differently.
- When addressing various social, healthcare and law-enforcement agencies, ASDs are presented clearly as psychiatric disorders.
A good aspie accepts not only his or her fundamental neurological difference, but also resigns to the fact that this puts him or her at a disadvantage in mainstream society requiring some form of advocacy. If AS-diagnosed persons were able to stand up for themselves, as some Internet advocacy groups would like to suggest, and form viable independent communities, the label would become meaningless with any perceived disability, stigma or social alienation removed. Yet such communities have never materialised because anyone diagnosed by a mental health professional has logically undergone a period of emotional distress and under-achievement in an important aspect of their life, meaning they are inevitably sucked into the mental health system with its focus on monitoring, medication, work placements and training schemes.
Clearly not all us show the same degree of emotional sensitivity to others. Some, notably Simon Baron Cohen, have hypothesised a dichotomy of systemising and empathising, with males generally faring better at the former and females tending to excel more at the latter. However, it is possible to construct an alternative explanation for these manifest differences, based more on experience, societal expectations and hormonal changes.
The Control Agenda
NB: Some may view any heading with the key word agenda as a sign of paranoia.
Since the inception of childhood in its modern form, the main institutions responsible for child development have been parents and the local community, with a key role played by religious organisations with a strong presence on the ground. Industrialisation saw the transfer of close-knit rural communities to towns and cities. Indeed to some extent the early educational gains of the renaissance as the growing British economy of the 18th and early 19th centuries demanded child labour. Children had little time to develop emotionally before they entered the tough life of work and assumed responsibilities we now only afford to adults. Some have hypothesised an end of childhood in the post-modern era, in which pervasive media reveal the secrets of adulthood (cf. Neil Postman) leading to earlier sexualisation and a blurring of the distinctions that for many centuries demarcated the key phases of our life. The late 19th and the first six decades of the 20th century probably represented the heyday of the family. Throughout that period a large number of children remained parentless as a result of precarious economic circumstances and migration to more prosperous regions, with many being either adopted by relatives in their extended family or sent to orphanages, run largely by the dominant religious institutions. Fifteen years after the official end of second World War and after a decade of continuous economic growth, by 1960 the vast majority of children were born into stable nuclear families with married parents. More important one parent played the role of primary breadwinner, while the other dedicated herself to multiple roles of house management, childcare, psychotherapy, learning support and public relations. As noted elsewhere, these tasks have now been professionalised. Before the word house-husband entered our customary lexicon, fathers were not absent from children’s lives as progressively shorter working weeks and more generous holidays enabled families to spend more time together. By and large society expected mothers to postpone their professional ambitions until their children no longer needed their vigilance, emotional and logistical support. The breadwinner + housewife partnership had considerable flexibility, especially if the family had a small business, with the female partner becoming a key team player in the family’s commercial dealings too. Until the late 60s most grocery shopping in the UK was still done in small family-run outlets. This model admittedly had many faults and inequalities. The primary breadwinner technically earned the family’s income, purchased or rented the family’s property and treasured belongings, offering his spouse spending money. In crude economic terms the housewife was an employee of her husband, but also a dependent in legal terms. For working class housewives without another source of income, low-paid part-time jobs remained the only option.
A number of economic and cultural changes have radically changed the domestic landscape in Western Europe and North America, and nowhere more so than in the UK. Even within a stable marriage, society now expects mothers to return to work as soon as their children start school. Indeed parents receive state subsidies for childcare if they return to work even earlier. Other European countries have lightened the impact of working mothers by extending maternity leave or even, as the case of Sweden and Norway, extending the same rights to fathers. However, for the first time in recent human history most children attend day institutions by the age of 3, with many starting as young as 6 months. If a mother wishes to pursue a career, that means the child spends 6-10 hours of his day away from her/his parents, home environment and often separated from an extended family or close-knit neighbourhood. On her or his return home, the child spends much of the potential quality time not interacting with her or his parents or exploring their immediate surroundings and treasured objects as in traditional households, but often glued to children TV or immersed in a kid-friendly virtual reality preparing them psychologically for a very different world to the one their parents knew. Again cultural comparisons reveal some notable differences among the the world’s most prosperous countries. Although Southern European countries have undergone much structural and cultural change over the last few decades, this has manifested itself mainly in lower birth rates, with Italian and Spanish women only having around 1.3 children each on average, smaller family units, much later ages of marriage and more stay-at-home adult offspring. Indeed it is not uncommon for Italians to live with their parents well into their 40s until they marry or are compelled to move for work. Even the most cosmopolitan-minded Southern Europeans, often spending a few years abroad for work experience or master foreign languages, have firm cultural roots much deeper than a mere affinity with their country’s number one supermarket chain, top TV shows, top video games or latest rock music. These phenomena are viewed as a superficial layer of international culture. Nowhere is this cultural affinity more embedded, by comparison with the UK, than in cuisine, usually simple with a healthy range of ingredients available locally. Few self-respecting Southern Europeans choose to save time with ready meals, replete with addictive additives. On three measures of lifestyle change, the UK stands at one extreme on an international spectrum.
- The UK has the smallest percentage of children growing up in stable families with both parents, with one parent dedicated to their upbringing in their pre-school years.
- UK children spend much more time watching television or immersed in other forms of electronic entertainment.
- UK children, especially from the lower social categories, are much less likely to eat wholesome meals at the table with the rest of their family.
However, within the British Isles we observe an additional social divide. The above trends are much more entrenched in the lower social classes. A recent survey showed that in the lower 25th percentile over 90% of the children had a TV set in their bedroom usually complete with a DVD player and game console, while in the upper 25th percentile this figure stands at just 50%. Needless to say, in Southern Europe with a much more outdoor lifestyle, even fewer pre-adolescent children have monitors or game consoles in their private space. Many family units with limited floor space do not even have a dining room table, but somehow make room for all sorts of electronic wizardry.
Some commentators view this metamorphosis of childhood as a sign of progress, focussing on other developments such as social disapprobation of corporal punishment both at school and within the family and a growing awareness or rather codification of children’s rights. Indeed many look back at the 1960s and 70s as an era of child abuse and intolerance towards people with different sexual orientations or neurological profiles. Nobody can dispute that various forms of child abuse and neglect have existed throughout human history, but as a rule social stability and widely distributed prosperity without the extreme income disparity that we see in modern Britain and in the US tend to reduce the potential social triggers of such abuse. Thus the new orthodoxy maintains that greater social intervention, more psychiatric screening and tougher laws are the best means of preventing child abuse and building a society more at ease with itself. Others [cite] have observed that media preoccupation with abusive adults, antisocial behaviour and dysfunctional families generates a climate of fear and distrust, so even some of the best parents, trying hard to cope in a frenetic society, are referred to social workers or the police. While many desperate cases leave social care professionals with little practical choice, we would dispute that state intervention into the private lives of families is the best way to tackle problems that have socio-economic and cultural roots. However, if the emotional problems that hundreds of thousands of young people undoubtedly face are categorised as personality disorders with a significant genetic component, the case for psychiatric intervention seems much stronger.
It would be way too simplistic to conclude that any single socio-environmental factor, be it the breakup of traditional families, addiction to video games or artificial colourings added to popular fizzy drinks, directly cause any of the new generation of personality disorders. One needs first to analyse the case histories of those diagnosed and identify obvious biological factors, which in the case of the extended autistic spectrum would separate cases of Kanner’s and regressive autism from the much larger group diagnosed on the basis of behaviour alone. Next we should reevaluate behavioural autism within the wider social context of early 21st century Britain. Not only do employers place a greater emphasis on teamwork and interpersonal skills, but to survive in modern public sector schools children arguably need to hone much more advanced social skills and adopt much more effective coping strategies if they wish to integrate within the mainstream social and learning environments. The diagnosis of Asperger’s, Tourettes, OCD and Social Anxiety Disorder has risen in concomitance with a general trend towards greater atomisation of communities and more geographically distributed social networks, with wide-ranging effects on our sense of self. In such a fluid environment it is not hard to envisage that some individuals fail to fit in and begin to exhibit behavioural traits that teachers, parents and colleagues consider maladaptive and which inevitably lead to social exclusion, which in turn may trigger the onset of more problematic psychological complexes. We see a rise in many other types of labelled syndromes, eating disorders, self-harm, lack of concentration at school or work and various forms of obsessive compulsive behaviour.
Lower-cased social conservatives tend to view the current situation through a different filter, focussing on unruly behaviour, lack of respect and falling academic standards, at least . When criticism of personality disorder screening comes from those who would like to turn the clock back to the 1950s when children allegedly knew their place in society and respected adults , the mental health establishment dons its progressive and liberal coat, advocating greater awareness and tolerance of the neurologically diverse. In reality at stake are different means of social control. Do we trust parents and the local community to raise tomorrow’s adult citizens or do we transfer this responsibility to myriad agencies run by the state or funded by large corporations? Media sensationalism serves to convince us that many parents, whether single or living together, are irresponsible and potentially abusive. Even teachers and community workers such as scout leaders or church activists often face allegations of child abuse. In recent years we have seen a huge decline in male primary school teachers, partly because the relatively low salaries on offer fail to appeal to this demographic, but also because many would-be school masters fear accusations of paedophilia. At a time when millions of ordinary children suffer from severe emotional neglect with parents often living apart or working antisocial hours and bullies rife at school, abuse has been redefined as specific acts in which only psychopathic adults indulge. Absent from this simplistic analysis, popularised by the red-top press, is the blurring of boundaries between adulthood and childhood, with both groups often treated as minors worthy of supervision, as noted brilliantly by Michael Bywater’s satirical Big Babies. In a nutshell we may think of the old adage ‘Treat people like monkeys and they might behave like monkeys’. There is certainly more than anecdotal evidence that the professionalisation of childcare and adult supervision infantilises both groups. Every mental health awareness raising campaign merely spreads the message that many adults cannot be trusted unsupervised. Far from combatting stigma this approach sows the seeds of distrust about conditions of which people were previously unaware, except in the more down-to-earth form of character and moods. A classic example is one busy mother’s reaction to her daughter’s tantrum in a supermarket car park. Most conscientious parents find such outbursts deeply embarrassing, but also need to prevent further occurrences and not succumb to the temptation to win their child’s temporary favour by satisfying their every whim and fancy to avoid public embarrassment. Ms Ball of Luton chose to lock her screaming three year-old daughter in the car while she returned to the supermarket to get some essential groceries, only to return five minutes later by which time a member of the public had reported the incident to the police. A few hours later a police officer turned up at Ms Ball’s doorstep. So what lesson did her daughter learn? “Naughty mummy, next time I want her to buy something I’ll just scream louder”. All too often child abuse is assessed by simplistic criteria such as smacking, shouting or temporary confinement, the latter being increasingly common as politically correct parents reject the former two options. Thus many parents not only have to hold down jobs, but often find themselves between a rock and a hard place when it comes to dealing with problem behaviour. An inability to assert their authority and win a child’s respect early on can have catastrophic consequences leading to much more traumatic family rows than short-lived humiliation a child feels at the receiving end of traditional means of parental discipline. Successful and self-confident parents respected by other close friends and family and integrated into a stable community find it much easier to avoid either corporal punishment or extreme capricious behaviour. Many professionals responsible for setting parental guidelines seem unaware of the stigma many parents in precarious employment and personal situations find themselves. If you’re under pressure at work, have just lost your job or been abandoned by your partner, you tend to lack self-respect with obvious ramifications for your relationship with your offspring. A child’s behaviour and academic performance has been shown to improve simply because their breadwinner parent has secured more rewarding employment, has greater self-confidence and thus is more successful at winning his or her child’s respect. In modern parlance a parent who lacks professional success and is isolated from the community is branded a loser, unworthy of respect. The media presents young minds with imagery of role model families with parents always keeping their cool, empathising with their kids by playing sport and indulging in youth culture and pursuing a successful career with plenty of spare time. Reality on the ground contrasts drastically with this rose-tinted vision of postmodern life. Few parents can hope to compete with those portrayed in 1990s American sitcoms, though many try their best often compensating for their failings in sport, dance, personal relationships and professional success by acquiescing to their children’s material desires fuelled by a multi-billion pound advertising industry. As a multitude of pressures produces a heightened level of peer competition at school, college and work, it is not difficult to imagine that many would rather leave a cultural rat race and join one of their own making. Parents are often made to feel guilty if they deny their children of the chance to compete culturally with their peers, which often means adapting to subcultures targeted at vulnerable youth markets. In many working class neighbourhoods of provincial Britain to win in the cultural stakes a teenage boy might need the latest and greatest game console with the most awesome first-person shooter game, especially if he fares badly at sport.
The classic portrayal of an aspie boy reciting bus timetables, collecting coins and spending hours on end obsessing with model railway bears little relation the kind of severe emotional problems experienced by millions of young people today and probably belongs to a bygone modernist era in which such pursuits were met with general approval. Early interest in mechanics and numbers can pave the way to a future career in engineering. Indeed the UK has a woeful dearth of competent engineers, often importing human resources from far and wide for routine tasks such as as railway maintenance or road building.
Psychologists [cite] observed interactions between engineers from Germany, Britain and some other countries who collaborated on the design of a new Airship in 2002 [verify]. Language was not the main barrier as English served as the lingua franca for all work-related matters. While one might not expect the German engineers to understand the subtleties of colloquial native English and its myriad regional accents, the setting in Germany meant most adapted to a more standardised form of English. Instead the main barrier proved to be the engineers’ attitude to teamwork. Anglo-Saxon engineers would thrive in technical meetings and at working in groups, while German engineers would thrive at creative autonomous work, often taking the initiative to introduce new features in line with their understanding of technical requirements and finding the endless technical meeting of their British and American colleagues a pointless waste of resources. Indeed the latter groups often proved unable to undertake any task without guidance or rather without the benefit of groupthink. Ironically this collective approach seldom reaches a consensus by considering the experience and views of all those involved, but rather tends to invite members lower in the pecking order to go with the flow. In any meeting of mind, some enjoy higher status than others and most participants, especially those more in tune with the teamwork ethos, would rather voice their creatively worded agreement than raise a contrary opinion or simply suggest new ways to implement collective decisions, but challenge those key policy decisions. Commercial organisations cannot afford to have large numbers of ambitious engineers or programmers working creatively on their own projects with conflicting approaches. In reality the teamwork ethos compels participants to adapt to the will of their team leader who in turn reports to a multi-tiered bureaucracy of project managers, who tend to view everything in terms of the allocation of human resources. Post-modern teaching techniques also favour a groupthink mentality. Most notably UK and US schools have a strong bias towards group work over whole-class teaching with extensive time reserved for homework, as practised in countries as diverse as Germany, France, Italy, Japan and Korea. The Anglo-Saxon models focuses on a child’s ability to integrate into a team rather than adhere to a core curriculum, taught to the whole class, while developing more specialised skills independently. In a group teaching situation a child who has finds it harder than others to mingle with his or her classmates is at a natural disadvantage, often lacking motivation and inspiration to learn.
One cannot fail to observe the huge rise in the UK in the number of learning support staff. One often sees large classes with over 30 pupils split into a smaller groups of 4-6 with one class teacher and a lower-paid learning support assistant working alongside a pupil diagnosed with a behavioural disorder and/or learning difficulty. Indeed other children fail to distinguish naughty classmates, who need special help because of their behaviour, from thick kids, who need special help because they can’t grasp key concepts. They all just receive the generic label of special needs, increasingly uttered on playgrounds in a derogatory manner. Learning support staff also seem equally confused, often applying the same approach to intellectually gifted children diagnosed with AS as to children failing to attain basic levels of literacy and numeracy for their age. However, rather than blame teaching staff for their lack of awareness of a growing array of personality and learning disorders, we need merely observe that children within the same diagnostic category exhibit a huge range of learning and behavioural patterns.
Social commentators have observed how the media treats the general population like children whose complaints and dissatisfaction are based on an incomplete or rather immature appraisal of the facts, i.e. they are simply not aware of the true complexity of the situation and are thus ill-qualified to judge tough decisions that politicians have had to take. This assumes, naturally, that politicians have a better grip on reality than average resident of a suburban sprawl estate commuting 30 miles to work everyday and witnessing first-hand the transformation of her or his country of birth. When someone cries wolf, simply stating the obvious, their opinion is often defined by leading political pundits as ill-considered or worse deeply prejudiced. A more rational analysis reveals that politicians tend to protect vested state or commercial interests, which may naturally not correspond with those of large sections of their electorate. This general establishment attitude has no unique qualities. For much of history the general populace just got on with their mundane lives owing due allegiance and respect to local leaders. With low material expectations most were content just to earn a living, so necessities like food, shelter and security mattered much more than abstract concepts like democracy. Indeed throughout much of its history Western democracy has really involved a consultation process with competing social and commercial forces with voting power linked either to one’s social status or wealth. Universal suffrage is a relatively phenomenon, but to last without rocking any boats or challenging elite interests it has to be micromanaged. One may look back to heyday of two party politics in the UK in which the Conservative and Labour seemed to offer voters alternative policies with the latter championing reforms to bring about a more egalitarian redistribution of wealth with a wider social safety net. Fast forward to the early 20th century and the main parties differ little of any of the fundamental issues of the day. Indeed the social forces that have given rise to the new generation of personality disorders started under a Conservative government and continued unabated under a Labour government. So why do ordinary people not rebel and form their own parties more representative of their true feelings? Let us consider three possible answers. First people are simply too immersed in their busy lives of work and entertainment to spare a thought for political alternatives, so they merely respond emotionally to the rhetoric of mainstream politicians, often taking the lead of popular media pundits. Second when groups do offer policies outside the mainstream consensus, they are quickly deemed extremist, prejudiced or simply naïve wishful thinking. Third, the media invest billions dumbing people down diverting attention from the real issues at stake, spreading fear and fomenting reactions that effectively empower remote institutions, e.g. a food poisoning scare may lead to the closure of small farms and traders and consolidate the domination of large supermarkets as only the latter can afford to meet new food safety regulations. So adults are expected to vote, but are only considered mature or worthy of respect if they exercise their electoral power within the confines of mainstream political parties. Here we see a dichotomy between largely upper middle class political activists, who have the time and resources to engage in the democratic process, and the masses who are merely expected to place a cross next to their preferred brand of the establishment party. As long as dissent can be confined to a small politicised minority or denounced as the wild rants of ill-informed plebs, it can be micromanaged. Undoubtedly the political insight of individuals within the general population varies enormously. When an infamous big brother contestant, later accused of racism, erroneously claimed Margaret Thatcher was leader of the Labour Party, media pundits had a field day. How can we trust ignoramuses like this to determine our country’s future direction, they wondered. That the then Labour leader, Tony Blair, followed very much in Margaret Thatcher’s footsteps taking her reforms to the next level seemed irrelevant, today’s youth are expected to know who plays for which team, but not necessarily to analyse their actions.
We see the same social dynamic at play in the management of any workplace. Some get promoted to managerial positions while others either specialise in technical roles or accept a lowly status. Presumably the skills required to rise through the glass ceiling relate not just to one’s professional competence, but to one’s emotional intelligence. If you lack people skills, you are effectively excluded from all client-facing or people-managing positions. You become a faceless implementer of requirements that others have set. The transition from a largely manufacturing and mercantile economy to a service-led information economy has led to a proliferation of sales representatives, project managers, advertising executives, consultants, public speakers and creative writers whose main role is to persuade others to buy products, change their working patterns or simply toe the corporate line. And they do so with increasing sophistication. Only a generation ago most workers had specific and largely methodical jobs. As long as they understood what was expected of them and could perform their assigned tasks to the management’s satisfaction and did not rock any boats or break any explicit rules, little else mattered. To succeed an engineer of the modern area needs an obsessive interest in their chosen specialisation, requiring prolonged periods of analysis and research to the exclusion of social niceties. Let us consider a technical feasibility study on the conversion of an old warehouse into luxury apartments, experience in structural engineering and hard geophysical facts are required. An analysis based on social osmosis, seeking guidance from the perceived integrity of other qualified experts, may lead to disastrous decisions, such as investing large amounts of capital into a project doomed to failure due to underlying structural weaknesses or wasting valuable resources on demolishing a building that was structurally intact and replacing it with a substandard building. To obtain an objective judgement, based on solid experience, you need to consult someone with a clear focus on the matter at hand, but easily swayed by emotions and thus influenced by peer pressure. Within a relatively short time span social networking and an aptitude to assimilate into a hive mentality have to varying degrees become prerequisites for most jobs in a post-industrial world. Indeed in many organisations we a social stratification at play, in which talented technical staff deemed to lack social skills are micromanaged by project managers, often younger than their human resources, whose role is to smooth relations between different team players, but in reality enforce an agenda determined by upper management. On closer analysis this burgeoning people management bureaucracy serves purposes other than efficiency or worker-management relations. It effectively prevents individual teamplayers involved in a small technical aspect of a larger project from seeing the whole picture.
- We should challenge the validity of the extended autistic spectrum theory (AST) as a meaningful diagnostic category, but stress that subgroups within it may have more consistent and identifiable causal pathways.
- Both psycho-social and biological factors may cause antisocial or even psychopathic behaviour. We can change the former by nurturing a more socially cohesive, egalitarian, sustainable and less stressful community, while the latter requires invasive intervention into people’s private lives.
- We should stress the wide range of symptoms, behavioural patterns, performance and outcomes associated with ASDs. They need not have the same causal pathways, though of course the AST (as defined above) can only be understood in its social context.
- ASDs tend to be defined by behaviour, which in my mind says little about their causes. A closer analysis reveals that a high proportion of those deemed to have severe autistic symptoms from an early age have other medical conditions pointing to a biological cause. Rather than focusing on the neurodevelopmental consequences of the underlying medical conditions, which may result in behavioural patterns now considered autistic, autistic spectrum theorists try to link their problems with the behaviour exhibited by other categories of perfectly functional human beings, whose behavioural deviance may be caused by largely psycho-social factors and some minor biological variables (somatopsychic).
- Biological factors are both numerous and complex and not necessarily genetic. Genes are little more than a blueprint determining the more physical and mechanical aspects of our personhood. The efficiency and sensitivity of motor and sensory processing may be influenced within the same species by minor genetic variations, but also by diet, contaminants, radiation etc.
- Neuroplasticity may also explain how some deviant behaviours may become so ingrained that a person finds it hard to unlearn habits that others consider dysfunctional or fails to learn skills that to others is second nature, e.g. my father never learned to swim or the fact I’m so bad at ball games may partly be attributed a lack of rigourous training in key stages of childhood. A brain develops post-partum fine-tuned specialised logical modules (or circuits) required to survive in a given cultural setting, e.g. in hunter-gatherer societies acute hand-eye co-ordination and premonition would be essential skills, while mental arithmetic would be of limited utility.
- Psychiatry. Recently we`ve seen a blurring of the distinctions traditionally made between psychology, psychiatry, psychopathology and neurology. As I commented rather provocatively on my blog site, we don`t really need psychiatry, but this should not be interpreted as an offence against individual psychiatrists who have the best interests of their clients/patients at heart. Indeed in my recent experience many psychologists, social workers and autism/personality disorder professionals adhere much more to the psychiatric model than many real psychiatrists, well aware of the psycho-socio elements in the bio-psycho-socio triad. Nobody can seriously doubt that some behaviours are either immoral or antisocial and others very dysfunctional, the issue at stake is whether a large section of the general population has significant cerebral defects that require lifelong intervention of one form or another. It is my understanding that psychology is the science of the mind and neurology the science of the brain. Criminology is self-explanatory and psychopathology suggests some people`s minds may be so warped as to be totally oblivious to the psychosocial consequences of their actions on others. Where does this leave psychiatry? To me the psychiatric model supports the notion that all deviant or unacceptable behaviour is caused by a defect in the person`s brain. In my mind we need psychology and neurology. Criminologists, depending how society defines criminality, may then investigate the psycho-socio-bio causes crime.
- Mercury and MMR: It stands to reason that if the AST is invalid then not all cases on this spectrum may be attributed to a single cause. The diagnostic rise did start before the introduction of MMR, but sky-rocketed in the mid 1990s several years after its introduction. However, we can only seriously link bio-chemical contaminants with regressive autism, in which relatively normal progress goes into reverse gear at between 18 to 36 months of age. I can certainly vividly remember my children`s key stages of development in this period. In short, as you are probably aware, there are two hypotheses. The first relates to the live measles virus in the triple jab. Donna Williams, (born in the same year as me), suggested regressive autism may be immunoglobulin G deficiency, but still strongly recommended the MMR jab for everyone else. I was very much in favour of having my two kids vaccinated (too many of Michael Crichton`s bio-scare novels maybe), while Stefania had doubts, fuelled mainly by an Italian friend of hers who rejected all forms of vaccination. The MMR jab in Italy at the time was thimerosal-free, while the UK variant was not until 2001 I believe. More important because of large anti-vaccination movement and widespread public scepticism, its uptake was as low as 50% in many areas, yet despite the occasional outbreak of measles very few cases of measles-induced brain damage or fatalities resulted. Indeed I can recall getting measles and rubella myself (but failing to get mumps) when most just considered a childhood disease that would help build your body`s defences. If anything what concerns me most is the media`s manipulation of this scandal (first playing it up largely through the Daily Mail and a Channel 5 debate and then setting up Andrew Wakefield as a fall guy, vilified especially in the Guardianesque liberal press. Now citing a Danish study showing no significant difference in the prevalence of autism between MMR-vaccinated and unvaccinated groups, the establishment appears complacent in its desire to push ahead with new mass medication initiatives. This has to some extent confused the public with a false debate about the efficacy of vaccines, rather than the causes of severe behavioural disorders. The second hypothesis, much more credible IMHO, relates to mercury and other heavy metal poisoning, especially in combination with high levels of testosterone. Intriguingly Dr J B Handley, a proponent of this thesis, cites Simon Baron Cohen`s research revealing a higher levels of testosterone in subjects considered on the autistic spectrum. More important, vaccines are not the only source of heavy metals. Some research, cited by Dr Handleys, shows that amalgam fillings not only pass the blood-brain barrier, but can be transmitted to newborns perinatally. Also exposure to various forms of radiation may cause neurological damage. Currently most controversy relates to the links between mobile phones and microwaves in general and brain cancer, but let us not forget the good old X-Ray, until the 1980s often used during pregnancy. I did find this odd link http://www.schizophrenia.com/prevention/radiation.html from what I`d consider to be a pro-psychiatry source (namely favouring the genetic causation of psychosis).
- Epilepsy: A sizeable proportion of ASD individuals, especially those with more severe emotional withdrawal, learning handicaps and stims, have at some stage had epileptic seizures. Obviously millions of epileptics do not exhibit autistic behaviour, but the seizures may affect different parts of the brain and in some individuals the brain may be better able to reorganise itself after a seizure. I mentioned the case of a young man I had worked with on a council project. He too had been diagnosed with Asperger`s, but required 24/7 support and the permanent presence of a key worker. It turns out he had regular epileptic seizures as a teenager and regressed rapidly after the age of 7. These are case notes his employability advisor divulged to me in confidence. I also know of someone who had been erroneously given strong anticonvulsants for 15 years ending up in a day centre alongside people with severe learning disabilities. When his medication was withdrawn, his mental faculties returned. Could we not simply be classifying all sorts of diverse cases under one happy umbrella.
- Possible causal categories:
- Rare genetic deformities of the brain.
- Heavy metal poisoning and/or exposure to radiation causing varying degrees of cerebral abnormalities affecting language, cognition, perception and fine-motor control.
- Excessive cultural emphasis on the importance of physical perfection and dexterity in culturally significant sports and pursuits, i.e. the coolness factor (see below) to the detriment of otherwise perfectly functional human beings.
- Emotional neglect and/or cultural alienation inducing emotional withdrawal and depression with the onset of many features associated with Asperger`s Syndrome.
Overlapping psychiatric labels
|Lack of eye contact
Depression, social anxiety disorder. In general a lack of eye contract results from lack of self-confidence either to due to one`s state of mind or self-image. The same person may exhibit widely different degrees of reciprocal eye-contact in different social situations.
|Deficiency in processing nonverbal communication, especially subtle facial expressions.
Semantic Pragmatic Disorder and to a lesser extent bipolar affective disorder. This deficiency is at best relative. Baron-Cohen and others have suggested a brain module responsible for processing nonverbal information often quoting research showing as much as 90% of information is conveyed through means other than mere spoken or written words. A classic example would be a weather forecast presented by an attractive scantily clad and soft-spoken woman on an idyllic beach. Clearly viewers would process much more information than meteorological data. Asperger`s individuals are considered literal thinkers. However, all aspies I`ve met not only respond to nonverbal cues, but actively use expressions and gestures to express emotions. The vacant expressions associated with a subset of the AS diagnosed can easily be attributed to a sense of alienation from mainstream social culture and in some cases to side effects of antipsychotic medication.
|Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
OCD, except in this condition the obsession itself is considered dysfunctional or maladaptive while in AS it is just an all-consuming fascination that excludes interest in a broader range of culturally appropriate subjects. However, a more detached analysis would reveal that a high proportion of the population have obsessive interest in a narrow range of subjects, except they do so in an adaptive and culturally appropriate way.
|Failure to develop peer relationships appropriate to developmental level
ADHD, Semantic Pragmatic Disorder. This really refers to the core reason many parents, teachers or social workers to seek to have their children diagnosed in the first place, a failure to fit in. AS-diagnosed children are often reported to be more at ease with teachers or
|A lack of spontaneous seeking to share enjoyment, interest or achievements with other people
Depression. As a rule a lack of self-confidence in social situations and a preoccupation with one`s own problems tends to exclude interest in other people`s lives and interests. My observations would suggest a huge range within the general population in the ability to empathise with other people`s lives. Those who succeed very well in this enterprise may find it easier to make friends and take on team-leading roles. However, the extent to which one can feign interest in all subjects or empathise with all predicaments is limited. Usually a socially adept person can empathise with a range of interests and emotions within the common experience of their culture. Thus this statement is simply a generalisation that holds true for most people diagnosed with AS. One reason some people may not seem so eager to share achievements is a general sense of inferiority in everything but their chosen specialisation.
|Stereotyped and repetitive motor mannerisms
Depression, Bipolar Affective Disorder: This criterion really refers to severe autistics. However, tics are not uncommon within the general population as a reaction to a traumatic experience or way of coping with an inferiority complex. The kind of never-ending stims, such as persistent rocking, associated with Kanner`s and regressive autistics are rare in AS individuals, whose mannerisms match more closely the kind of nervous twitches common in depressed persons in general. That these symptoms can be observed in large proportion of AS-diagnosed individuals proves little about their cause. Of note, many psychoactive medications, both SSRIs and antipsychotics, have nervous twitches as known side effects.
|Persistent preoccupation with parts of objects
Humanity: Obsessive interest in objects is characteristic not only of a depressed and withdrawn state of mind, but also of a phase of discovery and exploration. If someone had not fixated long enough on the tendency of logs to roll down slopes, the wheel may never have been invented. Most people fixate with a very narrow range of objects.
- The ADHD Connection: This condition has received more critiques largely because it is more readily diagnosed in the US, UK and other countries who follow the Anglo-American psychiatric model and because of the rather obvious role of large pharmaceutical multinationals in the promotion of this disorder, treated most commonly with methylphenidate. As most ADHD-diagnosed children show few signs of the kind of emotional withdrawal and obsessive interest characteristic of autistic spectrum disorders, including this category within the autistic spectrum would confuse parents of severely autistic children and the public perception of autism as a one-dimensional spectrum of varying degrees of introversion. However, on the ground hundreds of thousands of parents have their children first diagnosed with ADHD when they first encounter problems with social integration at school, only to have the diagnosis reviewed and changed to Asperger`s Syndrome when their child reveals a special academic talent and slightly longer attention span than previously feared. It certainly appears odd that the same child may first cause concern due to his alleged lack of focus and then due to his obsessive focus in one subject. Many social workers in the UK have observed that working class kids are more likely to be diagnosed with ADHD, while children with better educated parents tend to receive an AS label. Whichever way, in an alarming number of cases, Ritalin is offered as an integral part of the treatment. Diane M. Kennedy wrote a whole book, the ADHD Autism Connection, with a forward by none other than autism celebrity Temple Grandin. The last two chapters are dedicated to treatment and it should come as little surprise that overall the book is very much in favour of medication albeit emphasising that misdiagnosis may lead to the prescription of the wrong medication. Ms Kennedy not only see links with ADHD, but with Bipolar Affective Disorder and Manic Depression. If we extend the autistic spectrum to cover people liable to be diagnosed with these labels, then we may soon reach as much as 10% of the population. The fact is there are no neat dividing lines between these categories. Rather than infinitely extending the autistic spectrum, we should reassess its validity. It may only make sense when severe developmental impairments are observed within the first 24 months of life, with all subsequent emotional problems down to a combination of environmental influences interacting with one`s physical inheritance.
- Autism as a State of Mind: So far we have considered two interpretations of this catch-all term, a pervasive cerebral disorder and neurological variable that one may have to varying degrees. However, there is a third perspective. Autism is simply a state of mind common to the whole of humanity. In a nutshell, we may think of this phenomenon as “being totally wrapped up in oneself and the immediate physical world to the exclusion of the wider social world”. This is certainly our initial state as newborns. In the first days of life a baby can quickly adapt to surrogate mothers as long as her/his basic needs are met, but after a week or more of close proximity with a mother figure, her/his whole world becomes the mother figure and the fulfilment of her/his personal needs. To feel embarrassment, sadness, inferiority or alienation represents an awareness of, but an inability to integrate with, the wider social world. Thus a completely autistic person would feel no embarrassment or sorrow. At a party a genuine autistic, by this definition, would happily stand alone in the corner with tomato juice spilt all over his shirt playing a moronic video game on his portable game console, totally oblivious to the emotions of other human beings in the same room. By contrast a typical AS-diagnosed person would feel deep embarrassment and quickly sneak out at the earliest opportunity. The crucial variables here are our sense of self (cf. Kenneth Gergen`s Multiphrenia theory) and cultural influences on personal development (cf. Michael Bywater`s satirical book Big Babies).
I like this coinage, but it can logically only refer to psycho-social influences. Thus if autism, as a cerebral difference, may only apply to a miniscule percentage (0.2% by NAS statistics) of severely handicapped autistics, we have to move on to another definition of autism. If a person`s brain is unable to assimilate the full depth of recent cultural change, as in the case of many people with severe intellectual impairment, autism is an acultural phenomenon, but we take the above definition of autism as a state of mind culture may indeed induce autistic behaviour. Beyond the first few hours of postnatal life, nobody is completely autistic as defined above. Our subsequent development may lead us to exhibit various forms of awareness of and concern for other people`s feelings. Consider if you will the current craze among many urban teenagers to play load rap music on their mobile phones in buses and trains. This behaviour annoys a large proportion of passengers, though few complain. Do they simply want to enjoy the music, usually very distorted, without earphones or do they deliberately want to annoy anyone who does not share their musical taste? In other words to what extent can we define their behaviour as deliberately antisocial and to what extent are they simply unaware of other people`s feelings? We might define this as social autism, introversion not into oneself but into a small clique within a larger social group, resulting in total indifference to the feelings of those outside the clique. However, I’d dispute that in today’s interconnected and media-saturated world anyone can be truly isolated from the wider reality of mass socialisation. We just integrate differently with societal expectations.
Many have observed the absurdity that in modern Britain some of us hardly ever talk to our neighbours, but thinks nothing of communicating with friends, colleagues or just vague acquaintances thousands of miles away, just because they share an interest or indulgence with us. The logic of globalisation has persuaded many of us of the need to conform with remote global norms as taught in leading educational establishments, broadcast on TV and popularised via numerous high traffic Web sites, leaving aside generations of familial culture and leading a general distrust of recalcitrant neighbours still wedded to the old ways. So while we may gain friends in remote locales, we lose friends in the geographic community. Indeed even the concept of community has morphed from a group of people living in close proximity and sharing resources, services and values to one of an amorphous collection of human beings who share some special interest. Thus we have the gay community, the Java developer community, the Star Wars fans community, the Halo gamers community, not to mention the Autistic Spectrum scene. (Of note some European languages such as German retain their native term for the geographic community, but use the English word for virtual community). Unlike close-knit geographic communities, none of these communities can exist in isolation. Members of the Java developers community may be gifted programmers but lack a sufficient diversity of skills and social cohesion to form a viable self-sustaining community. Traditionally most geographic communities have had to develop some degree of functional autonomy for the provision of essential goods and services. Each community would have its highly skilled tradespeople, farmers, builders, joiners, market gardeners, bakers, fishmongers, butchers and more recently plumbers, electricians, mechanics and engineers. Individual members of the community would respond largely to community demands, which may naturally stem from geostrategic and technological developments elsewhere, but nonetheless as perceived locally. Fast forward to modern Britain and we find over 90% of the grocery trade controlled by a handful of supermarket chains. Geographic communities have been replaced by housing estates, which may attract residents from a wide geographic area with diverse ethnocultural backgrounds and thus little emotional loyalty to their place of abode. Supermarket chains compete to win planning permission to meet local demand, which itself depends on remote macro-economic conditions. Supermarket staff seldom learn the trade from close relatives or choose to pursue this career path. Rather they are trained to work as part of large corporations and usually view their employment there as a temporary money-earner. With the exception of managerial staff, few superstore staff remain in the same workplace for longer than two years. Thus lasting loyalty to the family business is replaced by transitory allegiance to a corporate entity.