Saturday, January 5, 2013

Conversations with "O'Cleary": Autism and Schizophrenia By David N. Brown Mesa Arizona

Previously published at:

One of the more esoteric areas of autism research is its relationship with schizophrenia. It’s probably not a question that most people know about, but among clinical psychiatrists and psychologists, there were decades of historic controversy and confusion over distinctions between autism and schizophrenia. When the late 19th-early 20th-century psychiatrist Eugene Bleuler first used the term “autistic” in professional literature, he was not discussing what we now consider autism, but schizophrenia. When Leo Kanner performed studies that would form the basis for the first diagnostic criteria for autism, several of his subjects had previously been classified as schizophrenic. Through the 1950s, 1960s and even into the ‘70s, there was ongoing speculation that autism and schizophrenia were interrelated, most notably a circulating theory that those diagnosed with autism in childhood would become schizophrenics as adults. (It is noteworthy that this theory went into decline at precisely the time when children diagnosed with autism under Kanner’s criteria would have been reaching adulthood!)
In hindsight, the fruits of this now-obscure controversy are a mixed bag. The case of Bleuler alone is highly instructive. Bleuler was best known both in his own time and in subsequent literature as a pioneering researcher in schizophrenia, and he favored quite broad criteria for defining the condition, and as late as the 1970s professionals were still debating how much to “tighten” the criteria.1 Furthermore, a number of traits of schizophrenia can now be recognized as at least superficially similar to autism, such as lack of “affect” or displayed emotion.2 From what is now known about both autism and schizophrenia, it is quite possible that he did in fact observe some individuals who would now be diagnosable as called autistic. On a darker note, Bleuler appears to have assumed an analogy between appearing withdrawn or detached, as is common in autism, and the landscape of outright delusion seen in schizophrenia. In hindsight, this was not only an unwarranted extrapolation, but a failure to recognize the strong possibility that an individual’s “withdrawal” might in fact be a response to social abuse.
Moving to the present, there are developments that could yet revive the issue. The professional literature has for some time been rather quietly recognized that a certain number of autistics are also diagnosable with “comorbid” schizophrenia. A number of researchers have gone further and proposed that autism and schizophrenia have the same or similar underlying cause(s) in genes and neurology.3 What may ultimately be of most interest is that a substantial body of reports has accumulated of autistic people experiencing schizophrenia-like hallucinations, without clear indications of full-blown schizophrenia. (For anyone who wants to go looking for examples, apart from online postings, William Stillman’s writings on the religious experiences of the autistic, with frequent paranormal overtones, may be as good a place as any to start.) This opens up the possibility of a discrete subcategory of autism spectrum disorders.
That will be as good a place as any to start my story.
I first found out that I was diagnosed with Asperger’s Syndrome in 2004. Before that, I went through a regular alphabet soup of diagnoses: PDD, PDD-NOS, ADD, ADHD, and not improbably some I don’t remember or never heard about. As far as I know, the one thing nobody suggested was the one I thought about the most myself: schizophrenia.
To me, the centerpiece of my ideas about schizophrenia and autism is the character of Zaratustra. I first came up with him a few years before getting the diagnosis, and I always felt that, in some way, he was a kind of alter ego to myself. After the diagnosis, I realized that his character pretty well fit the “aspie” distinction. To me, the most important aspect of Zed is that, no matter how far he gets from what anyone else would consider reality, he is always rational. In other words, what he does will always follow logically from what he perceives as real and what he considers an appropriate and desirable goal. Perhaps the reason why I feel such an understanding for his character where readers get confused is that I can really picture what his inner world is like. Perhaps that should be frightening.
In this process, I now know that I hit upon a very important issue in psychiatric theory and practice. As per the psychiatrists, the defining characteristic of “real” schizophrenics is that they are not just delusional, but fundamentally disorganized. Thus, they tend to do things that, on consideration, do not make a great deal of sense even in the framework of their perceived world. For example, if someone otherwise “rational” perceived that a table lamp was telling him to go out and kill his bank clerk, he would probably assume he was hallucinating. (Actually, as psychiatrists use the term, this wouldn’t even qualify as a hallucination, because the perception is rejected, but I prefer not to make that distinction.) Even if he did accept the voice as real, he would probably still refuse to obey because it would be illegal and amoral. Or, if he were like Zed, he would at least ask the lamp what would be in it for him.
What I find intriguing about Zed is that he represents a combination of traits that would be exceptionally dangerous in an actual criminal. By comparison, actual schizophrenic criminals tend, from a purely technical standpoint, to be unimpressive. They are as disorganized in committing their crimes as they are about anything else; even counting bullets may elude them. Thus, they tend either to get themselves caught quickly, or to fail entirely in doing the deed. But, now and then, I run across a real case of a criminal who is clearly delusional, yet quite successful in planning and carrying out complex acts of mayhem. Over the years, I have racked up quite a list. I haven’t cared to commit any of their names to writing, but I am sure you, the reader, can already think of at least one. Whether they are well-known is quite independent of their evidenced capabilities; the single individual I consider most dangerous is probably the most obscure, and I would just as soon keep it that way.
What first got me thinking about schizophrenia, however, came years before any of this. Now, it should go without saying that I have a very active fantasy life. I have also always been very interested in phenomena that must be considered either unexplained, actually supernatural, or else hallucinatory: UFO sightings, Bigfoot encounters, poltergeists, etc, etc. But, I can’t say I have ever experienced anything that made me feel either out of touch with reality, or in contact with something beyond ordinary experience of the physical world. My closest brush with anything like the uncanny is one childhood memory: Sometime in later childhood, I woke up and saw an orange light coming from under a door between my bedroom and a family room, which wasn’t at all like the family room lights. After a while, the light flickered and went out. As such things go, on the whole, this would qualify as downright boring.
Then, starting when I was 15 or so, I started to have a completely different kind of experience. It never felt like a hallucination, but it made me fear very much that I was losing my mind. To describe it, I don’t think I can do better than repeat a fictionalized account I worked into my Zombie Vegas! series: “He did not perceive it as sound he actually heard. Yet, it was a voice, with tone and pitch and inflection, and it seemed completely beyond his control… The Voice had started during middle school. He had never believed that it was anything but a fragment of his own psyche, which had not made things the slightest bit better.”
My “Voice” was the persona of a fictional character named O’Cleary, from a jumbled mess of an aborted science fiction novel I worked on from 8th grade through high school. His story was that he survives a battle with monsters by leaving his companions and hiding, and afterward tells everyone else that the monsters can’t be beaten. He was never a sympathetic character to me: He was a coward and even a traitor, and he was supposed to be in some sense a threat to everyone else. What he really was, to me, was a voice that told me that I was going to fail (especially in any efforts at romance), and when I did it would be my fault, especially for not trying hard enough and not being brave enough. I never believed it was a “Voice” from outside myself, yet I was absolutely convinced I had to prove it wrong.
I can see now that this was, in fact, pretty much the reverse of reality. As I have recounted, in junior high and high school, I was anything but timid about approaching girls. By any standard, I was, in fact, too aggressive and persistent in trying to talk to girls. For a good part of my life, I don’t doubt that this was directly fed by the voice. Thinking about it now, I wonder about “chicken vs. egg”. When it started, I really was very reluctant to talk to a girl, no matter how attractive and interesting she seemed. But, I don’t believe now that this was not nearly as much a matter of being afraid as it was of what I was comfortable with. Back then, I was still easing my way toward enjoying being around people. There was no way I was just going to cannonball into a dating relationship, and I never expected or even really wanted to. I could feel perfectly happy just watching someone interact with others. I could even enjoy fancying that I was like a zoologist, observing without disturbing. (That other people would be aware of being watched, and might not appreciate it, is another point which eluded me.) But when I started listening to the “Voice”, I was willing to approach a girl again and again, even as she got more and more upset.
This continued right into college, and I believe it reached a critical level right about the time I learned of my diagnosis. This brought me to a situation where I was probably as in love as I’ve ever been, but still told myself the young woman was “just” a friend. (In perfect hindsight, I think the real best description was “acquaintance”, but I think the thinness of the connection only shows the disproportionate depth of my emotional investment.) Soon enough, this reached the point where she took me to task emphatically enough that I believed she never wanted to talk to me again- and I really never did. In hindsight, I do not believe that was really what she wanted, but I was ready to assume disaster. In more perfect hindsight, I think on some level I knew that not talking to her at all could be the best thing for me. But this didn’t save me from being around her in all the same places, or keep me out of especially severe bouts of depression. During one of these dismal, drowsy spells, I seemed to think spontaneously, who would miss me if I carried out what had for some time been my strictly hypothetical “escape plan”.
Even now, I don’t feel ready to talk about what came after that. Apart from anything else, I can’t recall with any confidence what happened. Time spent reflecting on the Bible marked a turning point. Learning about autism and Asperger’s Syndrome helped, and, in fact, I’m not sure if I could have benefited the same way if I had been told of the diagnosis earlier. Probably most importantly, I started sharing more with friends. It also happened that, at that time, I really started to wonder whether the “Voice” I had always considered an echo of my subconscious might be something more, and not at all good.
Through this process, I benefited particularly from better understanding what a positive religious experience could be like. To me, the existence of forces and entities beyond ordinary perception has always seemed like a straightforward and reasonable proposition. I had no trouble finding enthusiasm for Judeo-Christian Scripture in particular, on an intellectual level. But a sense of really relating to God long eluded me, in no small part because many people’s ideas of “talking with God” seemed little different than me being harangued by the Voice. Even now, I don’t relate to the idea of communing with the supernatural that way. (Quite a bit of my feelings in this regard have come out through my stories with the pragmatically pagan Carlos Wrzniewski.) But, I have come to the point where I can recognize a sense of something more, or at least different.
I suppose that leaves just one more thing to tell, which is the one thing that seems completely unbelievable. Indeed, when I fictionalized this story, I hesitated to recount this part, because it seemed so much like the kind of contrived deus ex machina resolution that countless authors have beaten into the ground simply because they could think of nothing better to do. But this is what really happened: The Voice just stopped. Even before I finished high school, O’Cleary was no longer popping up in my inner world. Even my depressive episode in college never repeated itself. It has seemed to me the closest thing possible to an answer to prayer- and I’m willing to believe that it was.
1 Encyclopedia of Schizophrenia, Noll, 339-340
2 Schizophrenia, Hearher Barnett Veague, p. 4.
3 See eg. Yael Dvir, MD and Jean A. Frazier, MD, “Autism and Schizophrenia”, Psychiatric Times. Vol. 28 No. 3, March 2011.

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