Autism and Overlapping Disorders by David N. Brown Mesa Arizona

Previously published at
http://evilpossum.weebly.com/uploads/2/6/2/2/2622709/overlap.pdf

Autism and overlapping mental disorders
By David N. Brown
This is a PUBLIC DOMAIN document (dated 8/13/09). It may be copied, forwarded,
cited, circulated or posted elsewhere. The author requests only that it not be altered
from its current form.

Obsessive-compulsive disorder:
• AS individuals characteristically rely heavily on routines and rituals.
• Easily fixate on a specific activity or subject.
• Possible distinction in perceived significance of act
◦ In OCD, commonly perceived as matter of safety.
◦ In autism, may be seen more rationally as matter of comfort
◦ Priority for intervention should be to make sure behavior does not lead to
self-injury, damage to property or inappropriate behavior in public. Don't put
excessive pressure on an autistic person to stop a behavior that causes none
of these problems.

Attention Deficit Disorder:
◦ May manifest either as “comorbid” disorder or as secondary effect of autism
◦ In typical “public” settings (classrooms, stores, etc, etc.) “attention deficit”
symptoms are likely to manifest simply as a result of sensory stress
◦ Ritalin may be beneficial
 
Schizophrenia:
◦ Characterized by hallucinations, delusions and disordered thought and behavior.
◦ Autistics may have comorbid schizophrenia (believed to be rare) or experience
some symptoms (esp. hallucinations) without being diagnosably schizophrenic
◦ Significant distinctions based on response to hallucination.
▪ Rejects hallucination= not delusional
▪ Responds logically to perceived reality= not disordered
▪ An individual who is delusional but still “rational” represents the greatest
potential threat to self and others
“Delusional Aspie”: Zaratustra
• Is very sensitive to light, but oblivious to pain.
• Obsessive-compulsive tendencies
• Recounts what he considers real encounters with angels and demons.
• Bases his actions, including participation in sophisticated criminal enterprises, on these
perceived encounters.
• Responds to hallucination/delusion in calm and highly organized ways
◦ Ex. Shoots at demons, keeps accurate count of how much ammo is left!
• Motivations seem bizarre or wholly incomprehensible to others.
• Is obviously intelligent, and usually articulate.
• Is often violent, but these actions are consistently “cold-blooded” in nature.

David N. Brown
Mesa Arizona

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"Vicious When Poked With a Stick": Dubious Descriptors of Autism by David N. Brown Mesa Arizona

Previously published at
http://evilpossum.weebly.com/uploads/2/6/2/2/2622709/descriptors.pdf
https://groups.google.com/forum/?fromgroups=#!topic/misc.education/1o0jKhDGtAQ

A major concern for autism advocates is defeating myths about the autistic. These are mainly popular
misconceptions or outdated descriptions in psychological literature, but may include what even serious
professionals will believe and defend. Here are my picks for the worst autism myths.
 
Aggression?
One of the most vague of the common descriptors, perhaps especially among those trying to link
autism to mercury poisoning, is “tantrums and agression”. I find this perception reminiscent of a
critique I saw once of early studies of the Tasmanian devil. Such studies helped perpetuate (if not
create) the image of the Tasmanian devil as a uniquely ferocious and destructive animal. As the later
critic pointed out, these studies of the devils' behavior always read something like this: “Tasmanian
devil placed in barrel, then poked with stick by grad student. Viciously bit grad student's finger off.
Grad student given longer stick.”
The truth is that experienced clinicians have often characterized as passive compared to neurotypicals.
If it appears that an autistic has made an attack or other “aggressive” act without provocation, it is most
likely an illusion, created by one of several factors. The autistic may have been unable to communicate
a problem verbally, and so tried physically to “solve” the problem or draw others' attention to it. He
may have responded to a problem with passivity, successfully containing a reaction at first only to have
stress build up until he had a visible break-down. He may be unable to communicate the reason for his
actions, or not even try because he thinks others already know. Finally (I suspect most often), he may
have been driven to an inappropriate action by a group of bullies, and said as much, but been ignored
because the sadistic sociopaths who forced him to act inappropriately lied to clear each other and get
him punished for trying to fight back or escape.

Retardation?
One misconception which has been defeated, in professional sources and for the mainstream media, is
the idea that 75-80% of autistics have retardation. However, it is likely still to be encountered in some
“popular” sources, particularly those which claim autism as a form of vaccine injury. The rebuttal has
been that, while several old studies in which autistics were tested for IQ did produce such results,
further support came mostly from uncritical repetition rather than replication of results, and that the
results were unreliable due to autistic problems with communication. I, personally, rejected this hoary
statistic as soon as I saw it mentioned, based on an event I have not seen mentioned by anyone else:
Back in 1918, the now-infamous Yerkes-army study gave standard IQ testing to over a million
servicemen, including blacks who couldn't read and recent immigrants who spoke little or no English.
The “results” for immigrants and blacks were as bad or even worse than those of autistics. Thus, the
apparent “retardation” rate among autistics could and should have been recognized immediately as
what would be expected from any group of subjects with a limited ability to communicate.
 
Lack of empathy?
Another myth that there has been much progress toward overcoming is autistics lack “empathy” for
others (begging the question what the hell is wrong with “normal” kids who target the autistic for
abuse). Tests have consistently shown a real problem: Autistics fall behind others in applying “theory
of mind”, as measured most directly in “hidden object” tests. In the setup for the test, two children are
shown an object being hidden, and then only one is shown it being moved. The test itself consists of
asking the one who knows the present location of the object where the other person will look for it.
Children with sufficiently developed “theory of mind” will point to the original location, while those
without it will point to the current one. Autistic children do the latter well after same-age
“neurotypical” peers begin to do the former. The valid conclusion from this is that autistics tend to
assume that others share their own knowledge, thoughts and feelings. But many over the years have
dubiously defined the autistics' difficulties as a lack of theory of mind, and drawn the wholly spurious
conclusion that they have trouble recognizing that others have feelings at all. On the question (and
definition) of “theory of mind”, it would be better to say that it is impaired rather than absent in the
autistic: Autistics are clearly capable of recognizing other people as thinking and emotional beings,
rather than mechanical objects. The handicap is that when they try to envision the thoughts and
feelings of others, they have trouble coming up with anything but a repetition of their own thoughts and
feelings. Now, within the framework of this assumption, an autistic may go to great lengths to
accommodate others' feelings, especially by doing for them what he would want himself in the same
situation. But, of course, it is doubtful whether others will appreciate their actions or recognize their
good intentions.

To illustrate the subtleties of the problem, I will give an experience from my adolescence: From
childhood onward, I have found insects fascinating and even beautiful. I especially enjoyed finding the
shed exoskeletons of cicadas, left intact on tree trunks. They reminded me of crystal sculptures, and I
would always stop for a look when I found one. Once, I found a number of molts while exploring the
woods during a church retreat, and while I was examining one of them, a girl passed by and asked what
I was looking at. I just told her to come and look. From what I remember, I was excited about sharing
an interesting and beautiful sight with someone else. She took one look, screamed and left. (I don't
remember if she ran.) This took me completely by surprise, and left me disappointed and sad. But I
suppose she just thought of me as some boy who set her up for a “gross-out”.
 
Unable to “read” body language?
This final myth is one that, to my knowledge, is taken for granted among specialists. Indeed, I do not
consider it false, exactly. I think saying autistics don't register body language is like saying a car with
no steering wheel handles poorly on corners. What's said is true, technically, but it doesn't get to the
root of the problem. In my own experience, I accepted this fully as applying to myself, and when it
came to social interactions, it was entirely true. But, relatively recently, I have realized that I had set
something of a double standard for myself. I am extremely visually oriented, as seems typical for
autistics, and I certainly can follow body language outside of social situations. If it is an animal in a
zoo or a TV nature program, a creature in a science fiction movie, or a character in a cartoon,
movement, posture and facial expression are not just things I follow but things I find intensely
interesting. As I reflected on this, I had to ask myself why I had not been applying the same skills to
other people in real life social situations. The only answer I could come up with was that when I talked
to people, I would usually look away from them, and I recognized that as nothing more or less than
failure to make eye contact (another pervasive autistic trait). I have heard different theories about why
autistics don't make eye contact. For myself, I have been able to arrive at a very simple answer: Not
looking at someone makes it easier for me to follow what he or she is saying. Thus, it is at least my
personal experience that I do not have trouble with “body language”; rather, I have so much trouble
with verbal communication that it is hard to do anything else at the same time.

The well-known failure of “facilitated communication” inadvertently provides strong evidence that
autistics may have average, good or even exceptional grasp of body language. Facilitated
communication appeared to give the lowest-functioning autistics the ability to communicate despite an
inability to speak. Critical cross examination showed that autistic children were reacting to “cues”
from the “facilitators”, very much like the historic case of “Clever Hans”, a horse that appeared able to
do math problems until someone blindfolded it. The verdict on “Clever Hans” is that, while the horse's
counting was illusory, the horse displayed impressive genuine intelligence through its ability to “read”
human body language. Facilitated communication offers a similarly dramatic demonstration that even
the lowest-functioning autistics are capable of recognizing nuances in body language.
 
“Anti-social”?
A final perception I feel needs to be called into question is that autistics are solitary. I relate the
problem with this to a fine distinction in animal behavior. In the strictest sense, “social” animals are
those that not only gather in a group but work together for specific purposes. By this definition, a pack
of wolves is social in a way that a herd of elk is not. I have suggested the term “gregarious” for animals
that gather in large numbers without practicing higher social behavior. Similarly, the description of
“solitary” best applies to animals that are not just alone most of the time, but actively avoid each other.
(These distinctions inspired a joke in my description of the fictional species Archididelphis invicta: The
“gregarious” ones kill you if they don't like you, while the solitary ones kill you if you get near them.)
I suspect that the “natural” tendency of autistics is toward my definition of gregariousness: an ability
to tolerate the physical presence of others, despite a lack of interest in activities as a group. Where
autistic people instead avoid even being near others, I would predict that it is because others are doing
things that stress them or (as in my experience) intentionally abusing the autistic.

 David N. Brown
Mesa Arizona

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Responding to ANYtown by David N. Brown Mesa Arizona

Previously published at
http://exotroopers.wordpress.com/2012/12/17/responding-to-anytown/

So, I’ve let this go again for a while, and just when I’m ready to come back, I find a major intrusion from reality, and this time I do believe I have something to say about it that will fit here.

I am sure it would be redundant to do more than briefly recap recent events, and I would prefer to keep it briefer than usual: Once again, someone has committed what is known as a “spree shooting”. As is usually the case, it is reasonably clear that the offender is mentally ill. This time, not for the first time, the possibility has been raised that had an Autism Spectrum Disorder. For the last few days, autism activists have been pushing back against these reports by emphasizing that autistic disorders are not associated with violence, up to and including repeating the long-standing axiom that people who are mentally ill are more likely to be victims of crimes than to commit them. I must say, I disagree with this response. For one thing, I think if the goal is simply to downplay speculations about crime and disability, then the activists might be better off not commenting. Historical precedent would suggest that such comments are most likely to appear early and then quickly fade, especially under low-key communication by concerned parties with the media. For another, I believe that there are real and very fundamental problems here that are overdue for discussion.

While I see no cause to doubt the above-mentioned statistical talisman about mentally ill victims vs offenders, I have always had a feeling that this is missing the obvious, and probably more besides. The most “obvious” problem is that making a talking point out of this comes close to pummeling a man of straw. Given the dissimilar nature of mental disorders, nobody is ever going to claim that all the mentally ill are equally likely to commit a crime: Obviously, individuals as different as an agoraphobic and a clinical pedophile are not going to pose the same (if any) level of threat to others. Nor is anyone likely to make any serious claim that those with any particular disorder are more likely to be violent than not: Even in the prison population, the large majority are considered “non-violent”! The point we are really making the closest approach to is simply that the mentally ill population, and any subset thereof, can and should be approached like any other people group. All of which takes us precisely nowhere in applying what we know or can reasonably deduce about the demographics of crime.

One of the less obvious issues in the equation is what could be termed disproportionate threat. This can be seen at play on two levels. First, even “violent” offenders are not equally prone to violence: Of the subset of “violent” crime, a large majority the offenses are attributed to a minority of offenders (I distinctly recall seeing the very persistent 80%-20% ratio come up). Then there is another consideration, entirely “obvious” but difficult to quantify: Quite simply, some people, even if they are no more likely to offend, are capable of far more damage if/when they do. Spree shooters themselves are among the most obvious examples, and historically they overlap massively with the even more quintessential case and point, ex-military offenders. One of the earliest documented spree shooters and my personal pick for the single most dangerous individual to come to my attention was a decorated World War 2 veteran who committed a rare building-to-building rampage in 1949. (I don’t care to repeat any names in discussing this sort of thing if I can avoid it, but here’s “his” website.)

The same kind of issues can be seen at play for mental illness. Many conditions offer nothing but obvious “outgroups”, as in the already-mentioned example of agoraphobia: People who by definition avoid going out in public are by definition unlikely to harm members of the general public! Other conditions may be said to put the individual “at risk” to offend, but make for a liability in actually carrying out the deed. Schizophrenia is the quintessential case and point: Schizophrenics are characteristically delusional, not only seeing and hearing what isn’t there, but believing it. However, the “classic” schizophrenic is also characteristically disorganized. He might rob a bank because his cat told him to, but even if the cat also dictated one hell of a plan, there’s not much chance he would carry it out successfully. The presumable principle is that this kind of “crazy” is predictably self-limiting, and there’s no shortage of real-life cases to support the point. My favorite is a famous would-be assassin who was still pulling the trigger when his empty revolver was taken from him. The ability to keep track one’s bullets is a key test of the organized criminal, and entirely failing to notice when one is out is a strong indicator that one is not suited for the “job”.

But then, there are offenders who defy these “rules”. The WW2 veteran I mentioned was declared schizophrenic and institutionalized for the remainder of his life. (Reading between the lines, it seems likely that there were people in the right places who wanted to spare him, and/or simply avoid embarrassing questions, on account of his war record.) It’s very unlikely that such a diagnosis would be accepted today, and any appeal for clemency would be denied. While he was by all indications delusional in some sense, his actions showed far too much planning and self-control for the schizophrenia diagnosis (which, significantly, was “tightened” in the early 1970s) to fit at all comfortably. Even more importantly, there was no question that he deliberately targeted at least some of his victims, which under the modern requirements for an insanity plea would be entirely sufficient to establish that he knew what he was doing and therefore could be held legally accountable for it. What is ultimately most significant about this individual is that similar “profiles” can be seen to pop up again with other exceptionally destructive offenders, including the subject in the present incident. Even subtle details, particularly a reported lack of vocalization, can be seen to match up closely.

So, exactly what are we dealing with? It’s my long-standing pet theory (developed with a little help from a couple fictional characters) that there is a significant subset of autistic people who have a combination of “high-functioning” traits and schizophrenia-like symptoms, which I have termed “delusional aspie”. (See “Autism and Overlapping Disorders” and “Conversations with O’Cleary”.) At least some “spree” offenders do seem to fit this description. This could be considered nothing more or less than an example of a “comorbid” disorder, which for schizophrenia in particular has been documented for about as long as both conditions have been known. (In fact, historic controversies occurred over telling them apart!) But then there is another way of looking at it. A psychiatric diagnosis is, first and foremost, a description of a pattern of thought and behavior. If an “overlap” of characteristics from two or more “established” diagnoses is sufficient to produce an entirely novel “pattern”, then at some point one has to consider whether it is, for all practical purposes, a completely different animal. Unfortunately, in the time it takes for the “pros” to sort out this sort of thing, it’s quite easy for whole generations to slip through the proverbial cracks, particularly by a) being “shoehorned” into a clearly imperfect diagnosis and treatment simply because nobody has anything better to do with them or b) simply receiving no diagnosis or treatment at all because nobody will venture to put a “name” to what is wrong with them.

Then there is another, very fundamental issue of criminal demographics. One of the most pervasive problems demonstrated by application of proper statistical analysis to crime is that popular anxieties tend to direct community attention away from serious “inward” problems. 1980′s-era “stranger danger” and its stranger cousin the “satanic panic” flew directly in the face of hard data on parental abductions and homicides (read Coulrophobia- it’s about time someone did). White Americans perenially anxious about blacks have long since been shown that about 80% of murdered whites are murdered by other whites, and even more strikingly, about 90% of people actually murdered by blacks are other black people. Such results of hard data can also be extended to murkier areas of folklore. For example, there can be no serious doubt that any factual nucleus of Medieval and Renaissance “blood libel” legends of Christian children supposedly murdered in Jewish rituals were simply prosaic homicides, and most likely perpetrated by family members of the victims. (Ironically, that very opinion is expressed frequently and vocally in contemporary sources, obviously to no avail against the prejudices of their peers.) It even seems possible that evidently high numbers of Jewish victims in “routine” homicides (ie beyond overtly anti-Semitic mass violence in the “pogroms”), which could be an indication of religiously-motivated or simply opportunistic attacks by (self-described!) Christian offenders, were in fact mainly killed by other Jews.

I believe it shall be “obvious” where this is going. If one accepts the proposition that one can at least attempt to treat crime among the mentally ill like that of any other people group, then the most intuitive conclusion one can make is that the greatest threat to someone with a mental illness should be another mentally ill person! Such a dramatic proposition should by all means be tested. But so far, I have yet to see it even mentioned, and I felt that it was long past time long ago.

Now I invite further consideration for just how this would affect someone’s mental condition, and indeed their entire perception of the wider world. If someone with obviously limited ability to function in society is approached by someone with ill intentions and a condition that is far less obvious, then the former party is the least likely of all people to recognize the latter as anything but a “normal” member of the public. If the more “functional” party then abuses the other, the less functional party has no way to recognize what is truly wrong with the abuser. Instead, the abused party might very well develop the notion that the abusive behavior is nothing more or less than what any “normal” person can and will do given the opportunity. Then the only “reasonable” defense is to withdraw further from “normal” human contact, which will carry with it predictable deterioration in condition and “functioning” and may all too easily make the subject an even more convenient target for the truly predatory abnormal. Sooner of later, the victim might even start to develop a plan for revenge, retaliation or merely self-defense… and we all know where that road goes to.

I don’t think I want to write any more about this now, if ever. I would like to think I have said enough. Call it what life, and my idea of a good story, is like: No answers, jut trying to ask the right questions.

David N. Brown
Mesa, Arizona