Adam Blatner

I just read that "federal health officials" said that, using a wider screening for "autism spectrum disorders," guess what: more kids are picked up who fit the broader or looser criteria. Duh. If you loosen the criteria on anything, that increases the sensitivity to shades on what used to be the borderline and you’ll pick up more cases. So it was 1/114 and now it’s 1/88 who are considered to “have the disorder.” Yikes! Run around screaming. Something must be poisoning our water supply! Maybe it’s those immunization shots! Hysterical hair-pulling.

(I’m speaking now as a Board Certified Child Psychiatrist.) Come on, folks: First of all, consider that the “autism spectrum” is NOT a “disorder.” You don’t “have” it any more than you “have” ignorance. (Maybe the medical model and a diagnosis is fairly argued to apply in, say, 10%, the most severe types, but many are so mild that really what we’re dealing with is a lower level of talent for interpersonal engagement, or the perception of subtle non-verbal cues. It’s a temperamental variation. There are the less-than-socially-adept, and beyond that the socially rather awkward, then those we might “diagnose” as social learning disability. It’s a spectrum. (Joke: How do you diagnose extroversion in an engineer? Answer: He looks at your shoes when he talks to you.) Geeks. Then those who with the help of their parents in getting a diagnosis so they can obtain benefits, Asperger’s Syndrome, which varies from mild to severe.

Now the problem is that there are many spectrums of ability, of talent, for math, music, the different kinds of intelligence mentioned by Howard Gardner in his book, States of Mind. You can be bright in one and dull in another. If sports is your thing and music not, that doesn’t entitle you to a “diagnosis” of music disability, with an entitlement to remedial work.

So if we sang to communicate, people who are tone deaf would have a music disability. If we spoke by sign language, some clumsy folks—and there are as many of these as socially awkward folks or those who can read but not express themselves in writing, then they would have their category of “disability.” We need to draw back from reifying the word—making it a thing (from Latin, “res”). Indeed, a goodly percentage of everyone is well below average in ability in at least one skill or competence area. Just ask folks what they’re not good at and how not good they are. So it all has to do with where you draw the line.

Right now autism spectrum (largely populated by kids with social learning disability) is an opportunity for parent groups to get public funding for disability. This is a part of a culture that feels entitled to being subsidized for anything that it can qualify for. If you can find some group that will support your weakness, and enough momentum, call it a disability. Many addicts now demand to be considered to “have” a “disease” and based on that myth they become entitled to being treated with all the benefits attending, no different in moral quality than a soldier who had his leg blown off in the course of duty. And this whole culture of entitlement is fed on by Big Pharma who creates expensive medicines and profits, by lawyers who go to court to get benefits, by academia who seek money to do research on causes and treatment of disease. That’s what I mean by a culture of entitlement.

More recently the update of the American Psychiatric Association’s Diagnostic & Statistical Manual DSM, getting ready for a 5th revision, is wrestling with whether or not to include “excessive” shyness as a “disease,” or whether being very cranky at menstruation is a disease. Some folks use this logic: If medicine can help reduce the crankiness, that proves (??) it’s a disease. Come on! That is such sloppy thinking!

We should not think of concepts existing in a socio-economic vacuum, as a truth pristine upon which political actions can then be taken. Rather, often diagnoses follow social desires for subsidized treatment and services. There’s "gold" in them thar ills!

Dare I say that many of the people with “diagnoses” of anxiety, depression, and other non-major-psychotic disorders may not really belong in the category of “having” a disease. If you examined their lives even casually, it turns out that they suffer from a complex that includes
  – unrealistic expectations of themselves and others
  – a confusion of weakness in one area as proof of weakness in other areas—i.e., they overgeneralize their inferiority
  – bad habits of over-generalization, such as messing up “proving” they are losers and other forms of “catastroph-ization.”
  – other self-reinforcing negative beliefs
  – lack of psychological minded-ness or a clear strategy on how to straighten up their situation
  – multiple stresses in relationships confused or messed up in part by their own lack of skill and contamination with negative expectations
  – residues of trauma or stress or old-time parenting, religion, and other confuse-ments
  – nor should we underestimate the disorienting power of the psycho-social impacts of  growing urbanization, alienation, and other factors add to the lack of resilience in the face of stress.
… and this is only for those with milder problems. More severely disordered people have added to all this the escapist habits of a real or quasi-addiction that just doubles-down the fixity of the problem. So, as a colleague once put it, "they would have to be crazy not to be as crazy as they are!" This means not that real insanity is involved, but rather that they’d have to be remarkably dense to the impact and consequences of their folly—sort of a “What? Me Worry?” mind—to not be depressed or anxious about the mess they are caught up in.

Now, is this a “disorder” that should be “treated,” or should we embark on a cultural reorganization of our priorities? Perhaps it’s time that (1) people learn more psychological-mindedness and, as a result of that, some greater degree of resilience; and (2) we need a culture-wide, active critique of the subtly dehumanizing work and social norms such as the “myth of efficiency” in our workplace, the idea that effort alone can get good grades in all subjects in school, and don’t get me started about the psychosocial impact of the fear of hell in traditional religion.

In summary, it seems to me that psychiatry has become a disguised type of military medicine, with the “war” being the culture’s folly, and we’re supposed to “save” people who are just not “tough enough” to survive—the not so much shell-shocked (World War I term) or PTSD, but just messed up by the madness of the inconsistencies of what some folks delusionally think of as “civilization.”

Final anecdote. A British reporter around 1930s asked Mahatma Gandhi what he thought about Western Civilization. Gandhi-ji replied, “I think it would be a very good idea.”