Asperger’s Syndrome — a reflection

A propos of my discussion of Asperger’s Syndrome in this blog, a short book review in Salon  of Gary Greenberg’s recently published Book of Woe, by Laura Miller  http://www.salon.com/2013/05/05/the_book_of_woe_psychiatrys_last_stand/ deals with some of the same issues affecting other “mental disorders.”  It is an interesting read.  In the last paragraph of the review Miller mentions that Asperger’s Syndrome has been dropped from the official list (known as DSM-5) of recognized “mental disorders.”  In the case of AS the only things known are the symptoms (more or less) not either the cause or the cure.  That doesn’t mean that there might not in fact be a physiological basis for AS … and I for one wish there were, it would make things a lot easier to deal with … I am not arguing to preclude testing that would reveal that fact, if it is indeed a fact.  But if, as in the case of ADD, a generation of kids who were lost to education because of poor teachers or poor curricula (and the venality of corrupt researchers), are put on drugs like Ritalin, some for the rest of their lives, we have not only done further damage to the victims but we have not even identified the problem.  I believe the Greenberg book as reported in Miller’s review supports my argument that our cultural preference for the “medical solution” may prevent us from looking elsewhere — like making a critical appraisal of the values we live by.

They say that Mahatma Gandhi was once asked by a journalist, “Sir, what do you think about Western civilization”? and Gandhi was reported to have replied, “I think it would be a good idea.”  As I think most people read that remark, he wasn’t (only) joking.  Gandhi seemed to think that Western culture is at least … pre-civilized.  In trying to plumb what his comment may mean for us today, beyond what he probably had in mind about colonialism, … and in an attempt to discern the path that may lead to becoming civilized, I want to explore a “disease” called Asperger’s Syndrome (AS).

In researching what is known about this condition, I quickly learned that the short answer is “absolutely nothing.”  Not only is there no known etiology or cure, there is not even agreement about the package of symptoms that identify it.  They “guess” that it must have a genetic basis but no procedures so far support that conclusion.  The origins of its discovery are hardly more substantial.  The name comes from a German pediatrician, Hans Asperger, who in 1944 wrote about four “autistic” children in his care who happened to display the variance of having no loss of cognitive or linguistic development.  He called it an “autistic psychopathy.”  A propos of my point, it’s interesting that Dr. Asperger’s analysis is no longer considered adequate.  Classified as an “autism spectrum disorder”(ASD) some prefer to call it a “high functioning autism” rather than give it a separate diagnosis.  ASD’s were originally thought to be  diseases of children, but the diagnosis of AS in adults is increasingly common.  Could all this lack of clarity indicate that with AS we may be dealing with another example of medical overreach — calling things diseases that perhaps ought to be addressed as something else?

Besides, how has the “syndrome” even been identified with autism?  It seems that the one common factor that has the “doctors” convinced that there is an autistic pathology here is the lack of social skills, manifest in a decided absence of empathy — the ability to feel with others, and to “get” what they are saying about themselves and their needs even when they are not directly referring to them.  This is often accompanied by varying degrees of obsessive fixation on the technical details of things that are irrelevant to human interaction.  Here is a typical  list of “symptoms,” this one from the Mayo clinic:

Asperger’s syndrome symptoms include:

  • Engaging in one-sided, long-winded conversations, without noticing if the listener is listening or trying to change the subject

  • Displaying unusual nonverbal communication, such as lack of eye contact, few facial expressions, or awkward body postures and gestures

  • Showing an intense obsession with one or two specific, narrow subjects, such as baseball statistics, train schedules, weather or snakes

  • Appearing not to understand, empathize with or be sensitive to others’ feelings

  • Having a hard time “reading” other people or understanding humor

  • Speaking in a voice that is monotonous, rigid or unusually fast

  • Moving clumsily, with poor coordination[1]

After reading this list you may be as struck as I was about how little these “symptoms” differ from the behavior we encounter in “normal” people … and that we may even display ourselves.  I take this as a principal clue that we may not be dealing with a medical problem but with something of a different order altogether.  You may agree.  I have some thoughts about it I would like to share.

The hypothesis as question

Please be advised: what I am about to say is pure conjecture.  And because there is no data to back it up (or to refute it, for that matter) I will use a technique I have seen employed by some writers when they were moving into unchartered waters, and that is to present their ideas in a series of rhetorical questions that cleverly lay the responsibility for accepting the new daring thought at the feet of the reader.  Whether it actually works that way or not, the format should at least serve as a constant reminder of the hypothetical nature of the exercise.

If this is acceptable I would like to open with the following question:  Is it possible that what has been identified as Asperger’s Syndrome — an autism spectrum disorder — is really nothing more (or less) than the early and entirely subconscious internalization of the primary values and interpersonal dynamics implied in traditional western “christian” culture?   Corollary to this hypothesis, and contrary to the assumption of a physiological defect responsible for the lack of empathy, could the onset of the “disorder” have been due rather to an extremely — perhaps even overly — sensitive psychic radar, where a linguistically adept young child, newly emerging from the warmth of infancy, subliminally picks up “messages” sent by the social environment that encourage a disregard for feelings, both one’s own and those of others, and a preoccupation with the control of “things” in the service of one’s own accumulative interests?  It is significant that, unlike classic autism, the AS variant does not manifest itself in infancy with the signs of the familiar form of the disease: repetitive rocking motions, inability to speak, lack of interest in contact with others.  Classic autistic disorder is specifically distinguished from AS by manifesting itself quite clearly in the first 3 years of life, indicating a defect in the brain’s normal development of communication skills like the ability to speak coherently.  Asperger’s, in contrast, occurs without any signs of learning or language disabilities, and therefore cannot be diagnosed until that phase of childhood development is verified.  Hence it is usually identified later on in childhood, and in most cases not until school age or even later.

Some more questions: Could there be a correlation between these “symptoms” and the presence of these very attitudes (disregard for feelings … a focus on things, etc.) as priority values in our society and culture, or is their simultaneity merely a coincidence?  In this regard I would like to clarify that I am not suggesting that the child consciously absorbs these attitudes as values that would require thought and understanding.  It is my conjecture, rather, that something similar to the mechanism that is functioning in early language learning with its  highly complex grammatical elements, well before the use of reason, might also be functioning in the subconscious absorption of the psychic attitudes for social interaction.  Furthermore, wouldn’t something learned so early and pre-reflectively tend to manifest itself later as so intrinsic to the personality — not unlike language — that it would appear as almost organic?  No one remembers how or when s/he learned that third person singular subjects always require that the corresponding verbs end in “s” and that other forms do not, but by three or four years old the normal child says “I love you, mommy” and “daddy loves you, mommy” without hesitation or error … and applies the “rule” inerrantly to verb after verb, even those s/he has never heard before.  Would it not be logical to assume that the early developmental energies focused on the absorption of social tools so absolutely necessary for the survival of the organism, would be functioning across the board and that the suppression of feelings, absence of empathy, selfish obsession, and fixation on control of the physical environment, might actually be an example of a learning that is absorbed from others and imprinted on the psyche like language itself?  Isn’t it more consistent to assume that if these energies are functioning normally in language learning — the specific AS marker — that they would also be functioning normally in the appropriation of other social skills, rather than assume that this process breaks down or is being resisted only for these non-linguistic social issues?

Is it possible, in other words, that the source of the problem is not a defect of the human organism, but rather of the culture into which the organism is inserted and assimilated?  Is Asperger’s Syndrome a symptom of an uncivilized society?

Enter “christianity”

In presenting the hypothesis I made specific mention of “christian” culture.  What does “christianity” have to do with it?  Am I just grinding my axe?  Allow me to explain.

It was christianity that gave definitive shape to our culture.  For almost two thousand years the west operated on the assumption that what the Roman Catholic Church and its reformed offshoots taught about the nature of “God,” the world, the individual “soul” and its destiny was literal factual truth.  The western christian religion was not just a cluster of rites and ceremonies but a complete world-view — a way of life based on a comprehensive description of universal reality.  It was a story about reward or punishment in another world after death, administered by a demanding and watchful “God,” based on behavioral compliance during life.  The social dynamic was exclusively focused on individual “souls” who achieved their destiny by obeying the moral “law.”  Please observe: the central assumption of this christian story was the primacy of the individual.  “Salvation” was not a communitarian enterprise.  No amount of obedience on the part of one individual or group had any effect on the salvation of any other individual except perhaps by example.  All were on their own.  Whatever community existed (like the church) was focused on training the individual to “think about his/her eternal destiny” and “not to worry about anyone else.”

I would like you, dear reader, to stop for a moment, and think about that … christianity was a continent-wide belief system that remained unchanged for the better part of two millennia.

It makes me think about my “unchurched” friend “Charlie,” whose mother was a committed “born-again” christian.  Recently, in response to my questions about her feelings toward him, Charlie told me that “she simply doesn’t care … because she believes that we are all on our own before God.  She believes even my damnation will be for the glory of God.”  I was incredulous, but Charlie insisted.  Clearly his mother had adjusted her feelings to reality as she saw it.  There was no compassion much less anguish, and she was at peace with the world.

This was not a matter of moral failure, just the opposite.  It was just the way things were.  Nothing a mother or father could do, besides teaching and setting an example, could “save” their children.  No amount of committed love among brothers and sisters, husbands and wives, friends, relatives, neighbors, clans, villages, … even churches, would have any but an extrinsic effect on whether one of their number ended up in heaven or hell.  Salvation was not a community endeavor.  Does this sound familiar?  It pervades the culture.

One had to learn that little twist, because starting in  infancy the natural instinct of the human body is to reach out and cling … identify and feel safe in the bosom of the protective loving family, and in turn to protect the family, clan, community, that was the source of one’s survival and well-being.  In my own case, my spontaneous projection … that I feel safe because I belong to others and they belong to me, the organismic foundation of human community of every kind … no longer worked when it came to my eternal “life” with “God” and my “true community,” the Church.  I had to learn, and learn well, and as early as possible, that in spite of my spontaneous feelings, “God” and my family were really strangers to me … that we really cannot count on one another or trust one another … that life is not what it seems, that I am on my own … .  It’s an attitude that pervades the culture.

Wouldn’t it seem obvious that to the degree that a “christian” family had internalized those values that their attitudes and behavior even in areas that were morally neutral would embody and reflect them?  It is hardly imaginable that a normally functioning sensitive child would not pick up those “vibes” and begin to imitate and internalize adult attitudes — ways of feeling — long before the arrival of a reflective consciousness that could ratify emotional habits that were already in place.  I ask emphatically: how is it even possible that the child would not absorb these things?

At this point, someone may object:  If, as you claim, these patterns are in conformity with what you are calling “high priority values” in society, why would they ever be identified as a problem?  If your hypothesis is correct, how could such behavior ever come to be considered a pathology?   Why is it not considered absolutely normal or even desirable?

That might seem logical, and in fact some parents are quite happy to see that their children are,  what they like to call “competitive.”  But, I would respond to the objection by saying that it is obvious that the patterns in question (lack of empathy, suppression of feelings, obsessive fixation on one’s own interests, etc.) are in fact dysfunctional for social interchange.  Society depends upon empathy, compassion, etc., and does not expect that the self-interested motivation associated with “saving one’s soul” would generate this level of sociopathology.  And at the conscious reflective level it need not.  But why not?  For those who have not absorbed this social currency at the pre-reflective level of infancy — i.e., those who do not have AS — it is not a problem, for their organismic spontaneities are functioning normally despite their moral obligations as consciously understood.  They do not consciously countenance selfishness, despite the self-interest grounded by the doctrine of individual salvation.  Isn’t “love” itself a christian commandment?  But we must realize: the “syndrome” I’m speaking about is not a conscious reflective reaction.  It is a pre-reflective psychosomatic childhood absorption, just like language … and like language it cannot explain itself nor correct itself for it has no theoretical basis for judging itself.  It is absorbed whole cloth and appears to all observers, including the “patient,” as intrinsic to the organism.  It is, insofar as there is such a thing, the psychological bottom line — the core of the onion.  Doesn’t this conjure up the blackest of nightmares: physiologically healthy human beings of impeccable moral compliance who are incapable of compassion?

Does the christian “command” to love resolve the paradox?  Not at all; it reinforces it.  Please note:  there is an insurmountable incompatibility between the spontaneity of love and an “act of love” elicited out of the self-interest of gaining reward.   Wouldn’t it have been unlikely for an omniscient “God” to issue such a command as a condition for eternal life in another world, knowing that compliance would be skewed — motivated by the desire for gain, or more crassly, to avoid punishment?  Doesn’t the expectation that one will behave in a loving manner only for one’s own benefit after death require a schizoid self-division and the subordination of altruism to self-interest?  If this is true, is it any surprise that the super-sensitive pre-reflective child would pick up those subliminal feelings by osmosis and long before the cere­bral double-think, which allows adults to sustain two mutually incompatible emotional postures, entered the picture?  Once in place, isn’t it plausible that early rooted patterns — not unlike language — would later in life resist change, much as for many trying to learn a new language as adults is like hitting a brick wall?  Could it be that it is this mechanism of the pre-reflective absorption of emotional attitudes directed toward self-interest … attitudes which are later camouflaged in adults because they are made operative in intentionally benevolent behavior (obeying the “command” to love) … that accounts for both AS as well as the identification of those attitudes as pathological?

Has traditional christianity, in focusing exclusively on behavioral compliance (and if “reward and punishment” is the motivation, what other kind of compliance can there be?), unwittingly encouraged an emotional configuration that in fact is the foundation of psychopathic and sociopathic personalities?  Has the christian insistence on the rectification of behavior ignored the issue of the rectification of perceptions, attitudes and emotions?  Have we “cleaned the outside of the cup and left the inside full of greed and self-indulgence”?

Doesn’t this suggest that the transhistorical christian harnessing of the moral code to reward and punishment necessarily entails an obsession with self, produced and sustained by the very structural foundations of the culture — its sacred bases?  Couldn’t such a culture be legitimately called schizoid because it involves a split in the personality goals and emotional self-projec­tions of the individual?  Doesn’t this not only rob the individual of an emotional integrity to which his/her organism is naturally inclined, but also set up obstacles to future reintegration that are so impassible that only the uniquely dedicated can be expected to persevere and overcome them?  Doesn’t this contradictory use of anti-social motivations to drive social life … inevitably resulting in social and individual self-destruc­tion … merit the label uncivilized? 

Now what … ?

So many questions.  I guess the ultimate question is:  now what?  … what does it all mean … and where do we go from here?  How do we become “civilized,” or in this case what amounts to the same thing, how do we reverse Asperger’s Syndrome?  It is interesting that the medical authorities, in the absence of any known physiological or chemical cures, suggest “behavioral and cognitive therapies.”  That is stunning.  Do you realize what that means?  “Behavioral therapy” means the application of “rewards and punishments” to elicit changed behavior.  How delicious an irony is that?

This tells me two things: one, that whether AS is a disease or a collective spiritual myopia, the remedy is the same, so my conjectures were not so daring and dangerous after all.  And two, we’re back to rewards and punishments which can only change behavior.  What about our feelings?  Will they never be healed?  Perhaps by “acting as if,” they will, over time; it’s the basic premise of behavioral therapy.  But the very notion of reward and punishment as it will have to function in this therapy, if it’s not to continue producing the same baleful effects, has to be taken as metaphor: for the “reward” must be understood as “becoming whole again” and the punishment “remaining internally divided.”  There really is no literal reward for there is nothing to “get” … nor is there anything to “get” from what we “get.”  The goals are entirely internal.  There aren’t any “things” to lose by failing … to the contrary, oddly it is victory that usually involves losing things … because it means “letting go” of the false self-enhancements of accumulation.

Empathy, in other words, the very power to love resident in our bodies of flesh, is its own reward — like any work of art.  To re-learn empathy is to rediscover and recover our bodies our selves — it is, in fact, to be “saved” in the only “salvation” there is.  The reward is to finally become what we are: the mirrors — the sons and daughters — of LIGHT/LIFE reflected, reproduced in our bodies our selves … as lovers … us loving us … not me saving myself.

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3 comments on “Asperger’s Syndrome — a reflection

  1. theotheri says:

    Tony- I think your understanding of Asperger’s may be somewhat incomplete. You are undoubtedly right in your conclusion that its expression is culturally influenced. The form most of our actions take is. Our language, values, expressions of intelligence,musical and artistic talents, even psychopathologies are expressed differently in different cultures. For years, Puerto Rican women living in New York were over-diagnosed as suffering from schizophrenia until psychiatrists recognized that some behaviors which were generally considered extreme among the white English-speaking immigrants was culturally normal among Hispanics.

    You are also right that there is much we do not understand about autism, but it is not so to say that we know “absolutely nothing.” We have some idea of its bio-chemical substrate, and we know that the family and educational environments can greatly influence the level of social sensitivity that an individual eventually learns. Some of the most significant research is being done here at Cambridge University in England by Simon Cohen Baron. His conclusion is that the capacity for social empathy exists on a scale in much the same way as does intelligence. So there are individuals who are highly socially intuitive at one side of the scale, and those at the other extreme who are extremely challenged in their attempts to understand the feelings and needs of others. (Asperger’s, by the way, is not necessarily characterized by high intelligence, although some extraordinarily intelligent people, especially those gifted musically and mathematically – Newton, Einstein for instance – may have suffered from Asperger’s.

    However, and this is something your post does not seem to appreciate, there is an essential difference between an inability to read others’ feelings and an indifference to those feelings. It is quite possible for the autistic person to care quite deeply about the feelings of others and often are tormented by their misunderstanding of others. I know an Asperger’s adult who as an adolescent used to stand in front of a mirror to look at the expression on his face in order to help him guess what his mother was feeling when she had a similar expression. This is a totally different dynamic from your friend’s mother who seems indifferent to her son’s fate. There are, of course, those who are completely unaware of their own “blank spots,” and often think of themselves as highly intuitive when they are actually living in a kind of “colour blindness” in relation to others’ feelings.

    I have a streak of Asperger’s in my own family, including members who have dedicated their lives to trying to help the poor. For that reason, I have often wondered if I am among those who are not as insightful as I think, but I have this devastating suspicion that I would be furious if anybody had the nerve to tell me so. Simon Baron Cohen has constructed a test available on the internet which I think is a useful, if not an air-tight diagnostic tool to help individuals identify where on the “empathy scale” we may be. The list you quote from the Mayo Clinic is almost useless in my opinion, if not often simply wrong. But it does reflect just how extraordinarily varied Asperger’s is in its manifestations. In traditional cultures, I think women will often express it is overly-submissive behavior, while men express it in overly-domineering ways, influenced undoubtedly by traditional male & female roles in Catholicism as well as in many other religions.

    I do agree with your view that the emphasis on salvation of the individual separate from the community as it is expressed in Christianity is psychologically seriously limiting, if not positively destructive. But its potential damage is in an expression of egocentric self-satisfaction and ultimately an indifference to others, which as I say, I do not think is the core of Asperger’s, which is closer to something we might call a learning difficulty.

    • tonyequale says:

      Terry,

      Thanks for filling out the picture and for the balance. I want to repeat, however, that I am not talking about attitudes, I am talking about disabilities, analogous to language disabilities. What I am suggesting is that in light of the fact that AS does not present with language disability (thus differing from classic autism), that the disability in the child is the result of an osmosis — not unlike language learning — that picked up from the attitudes of the adults in the social environment. The attitude in the adult gets translated into a disability in the child, because the feelings are absorbed and become part of personality bedrock. Charlie’s mom was not disabled, she had a moral attitude derived from a “realistic” reading of her traditional christianity. Charlie is the one who might have been infected with Asperger’s because he might have picked it up at that time in life when our bodies are conformed to the psychic environmnent. But that’s my point. Emotional abilities — like language and empthy — are a subliminal assimilation that binds to the core of the person. Of course they can be affected by hormonal or organismic defect, but they also can be shaped or deformed by the psychic environment.

      I also repeat that my hypothesis is conjecture, but it is plausible. But so is most of what I read in researching the topic. The genetic and chemical theories were also conjectures and plausible. I don’t mean to rule them out. But we have to be careful of prejudice. I think having exclusive recourse to the medical paradigm may be misleading, and the inclination to throw drugs at it might be even more damaging, especially since drugs tend to become permanent routines. All acknowledge that the drugs prescribed have no direct effect on empathy; they are designed to reduce the anxiety and depression generated by social failure. For recovering empthy they prescribe behavioral therapies.

      Tony

  2. Bob Willis says:

    Tony,
    If someone tells you that he knows the cause of Asperger’s (or most other psychological conditions), I would suspect that he is either ignorant, deluded, or lying. Psychological distress comes out of a multiplicity of factors; that of a given person flows also out of the varied idiosyncrisy of his or her life experience. Professionals may prattle on about syndromes and symptoms but are hard put to come up with causes. Therefore, you have as much right to your hypothesis as to causes as anyone else has to his or hers.

    Many years ago Carl Rogers told me of an encounter he had with the psychiatric head of Camarillo State Hospital in California. The fellow had learned about the (then new) encounter groups that Carl and others were leading. He inquired whether a high-functioning patient of his, a middle-aged man suffering from schizophrenia, such that he sometimes experienced hallucinations or had other delusions, could attend one of Carl’s groups. Carl asked, “Does your patient have a name?” The psychiatrist responded, “Yes.” “Then,” said Carl, “he is welcome.” So much for learned diagnoses!

    I have no doubt that mental conditions, be they healthy or unhealthy, are influenced by the cultures in which the person is embedded: familial, interpersonal, local, class, economic, racial, national, and also religious. Rogers spent his professional career attempting to explain how psychotherapy works. He finally concluded that the therapeutic relationship–the interpersonal culture created by therapist and client together– is both the necessary and the sufficient cause of healthy growth and development in therapy.

    From years of working with families in therapy, I know for certain that families form their members through a kind of osmosis, often unspoken, often indirect. I recall a mother of two teenage girls. She brought them to therapy so as “to get them under control.” One day the girls were complaining that she never let them go out, never let them attend parties with their friends. She retorted, “Oh, I know what happens at those parties, all that drinking and drugs. And I know you wouldn’t have enough sense to choose the drinking.” There she sat, a delinquenogenic parent in a dark tweed coat and a high-buttoned blouse, the very picture of propriety.

    Kids in families unconsciously seek out the way they may,separately and individually, gain the attention and respect of their parents. They discover unique roles, one that no other sibling has absorbed. And so he or she becomes a mascot, or a star, or the responsible one, and so on–not by any conscious choice nor by any specific direction from anyone else. It all happens by osmosis.

    You are right on in your protrayal of the schizoid nature of christianity as it is currently practiced. On the one hand, we are counseled to “love one another”; on the other hand we are urged to be perfect and correct and sinless in order that we may earn heaven for ourselves. In this world love becomes “doing the right thing” so as to be holy.

    One of the most amoral persons I ever met was a certain Jesuit moral theologian. He was also my so-called religious superior. He once admonished me that I would be ordained only “under protest” as I obviously, to him, did not know how to love properly as a religious man. As I tried to understand his problem, I asked him what he would do if he came upon a “man who fell among robbers” as the Samaritan had. “I would see to his wounds, give him some money, and get him up.” “Then what?” “I would continue on my way.” “Oh,” says I, “I now see the difference between your way of loving and mine. You think love is all about correcting a problem when you see it; I think love is all about joining with others in our common journey. You would pick the victim up and then leave him; I would pick him up, go with him to a diner where we would have a beer, a good meal, and searching conversation. Then together we would decide whether we would travel together or go our separate ways. For you, it seems, involvement is improper in a religious man.” As I left that illuminating meeting, I recalled a remark attributed to Goerge Bernard Shaw, “The only problem with Christianity is that so few try it.”

    My erstwhile superior had no need for empathy, no need to decipher social clues, as he had no need to be in relationship. I would rather be suffering with Asperger’s Syndrome for I would, at least, then, know I was missing something very, very important—love.

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