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How to Raise the Asperger's Child

No magic, just common sense

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Overview | Asperger Syndrome | Psychiatry and Psychology | Parental Responsibility | Feedback | References

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I would like to discuss a recent MSNBC.com article that describes what seeems to be a breakthrough in Asperger's treatment. The story describes how parents of an out-of-control Asperger's kid hired a special consultant, who visited for a week, set firm rules, reëstablished family discipline and collected a handsome fee. The parents seem very happy with the results.

According to the story, this wasn't an ordinary parent-child conflict and the parents were clearly out of their depth — they couldn't simply tell their child to behave or face the consequences. If they had, it might have come out that they had disciplined a handicapped child, one suffering from a mental illness, in an inappropriately ruthless way.

So, instead, the parents hired a special consultant, a mental health professional, who did what the parents wouldn't — she imposed a level of discipline appropriate to the circumstances. She established new behavioral rules, a rigid system of rewards and punishments, close monitoring, and a strict connection between actions and consequences, both good and bad.

As I read the article, several questions occurred to me. Couldn't the parents do this on their own? Did they need the services of a special, expensive consultant to tell their son he had to brush his teeth or face the consequences? But this leads to more general questions — questions I will answer in this article:

  • What is Asperger syndrome?
  • Is a psychologist a doctor?
  • Is psychology a branch of medicine?
  • Do mental illnesses have the same status as medical illnesses?
  • What should I do for my mentally ill children?

Many of my readers will be surprised, even shocked, by the answers.

Asperger Syndrome

What is Asperger Syndrome?

Asperger syndrome is commonly described as a comparatively mild condition, somewhere between Rational Man and Rain Man. Asperger's sufferers are pictured as having limited nonverbal communication skills, a lack of empathy and general social comprehension, a tendency to focus on a few uncommon interests, and physical clumsiness.

Unlike most mental illnesses, an Asperger's diagnosis isn't particularly stigmatizing, in fact, it has come to be seen as desirable. One reason is the roster of those said to have suffered from Asperger's, a list of luminaries that includes Thomas Jefferson, Albert Einstein, and Bill Gates.

Some of my readers will see where this is going: start with a condition difficult to distinguish from ordinary behavior, add a reverse stigma (meaning a desirable outcome), throw in a list of very famous, accomplished people said to have "suffered" from it, and the result is ... parents who will go out of their way to acquire the diagnosis for their children.

According to Allen Frances, the editor of DSM-IV (the "bible" of clinical psychology) and the person responsible for making Asperger's an official diagnosis, the true Asperger's occurrence rate is "vanishingly rare." But its inclusion in DSM-IV gave it a patina of respectability, and the number of diagnoses exploded, far beyond any plausible estimate of true sufferers. Frances now feels the diagnosis is radically overused, in a way that he and his colleagues never foresaw or intended, indeed it seems that more than 90% of present Asperger's diagnoses are nonsense. I've already given one reason — it's a fashionable label to acquire, a way to set yourself apart from the mundane masses. Another reason is acknowledged by Frances: "In order to get specialized services, often one-to-one education, a child must have a diagnosis of Asperger's or some other autistic disorder" ... "And so kids who previously might have been considered on the boundary, eccentric, socially shy, but bright and doing well in school," instead "... get the diagnosis of Asperger's disorder, [and] get into a special program where they may get $50,000 a year worth of educational services."

What does this mean? It means most people with an Asperger's diagnosis don't actually have a mental illness, and virtually anyone can get an Asperger's diagnosis. It means parents and teachers both have a tangible, economic incentive to acquire the diagnosis for children under their care. But it turns out the symptoms associated with Asperger's are also the symptoms one sees in another kind of person — an intelligent one. Young intelligent people also tend to lack empathy or social skills, be physically clumsy, and have interests that an average person might find peculiar. But intelligence isn't a mental illness, and it may not serve society's interests to stigmatize intelligent people as though their intellectual gift is a treatable illness.

Above we read that Allen Frances, editor of DSM-IV, freely acknowledges that most current Asperger's diagnoses are nonsense. And by reading further, we discover that psychologists now realize their mistake, and Asperger's is being removed from the next edition of the DSM. To see how so many people could be misdiagnosed with Asperger's, how Asperger's could morph from an uncertain mental illness into a certain fad, we need to examine the field of psychology, the source for the condition and the diagnosis.

Psychiatry and Psychology

Is a psychologist a doctor?

Since its inception, psychology has struggled to acquire the standing of a medical field, but with only modest success. The central problem for psychology is its focus on the "mind," a hypothetical entity thought to share accommodations with the brain.

Recent dramatic advances in mainstream medicine, primarily the abandonment of methods that fail to take evidence into account, have only served to increase the isolation of psychology and psychologists, who continue to rely on anecdote and belief. The Asperger's story is a case in point — it was introduced without any concrete evidence that it referred to anything real, it became wildly popular after being included in the DSM, now it is being abandoned after an epidemic of bogus diagnoses. It seems that Asperger's went through all these stages without anyone attempting to study it scientifically, to see if it actually meant anything.

At this point it is fair to ask whether Asperger's is an isolated example — how many mental conditions have been introduced and then abandoned in the way that Asperger's was introduced and is being abandoned? Well, as it turns out, there are no mental illnesses that have stood the test of time. Many conditions once thought to be mental illnesses (schizophrenia, bipolar syndrome, autism and others) are now recognized as physical illnesses with psychological symptoms (a "true" mental illness would be an illness of the mind, not the body). Many other conditions once thought to be treatable mental illnesses have been abandoned for lack of substance or because of gradual enligtenment:

  • Dysaethesia Aethiopica — a bogus mental illness applied to African-American slaves to explain their lack of industry. The fact that they were slaves seems not to have been taken into account.
  • Drapetomania — a bogus mental illness used to label the behavior of African-American slaves who, if given a chance, would run away from their masters. Imagine that.
  • Female hysteria — utterly bogus, but once a very popular diagnosis, often applied to women who petitioned for civil rights.
  • Vapors — a contentless, catchall diagnosis used to explain anything and everything. Completely bogus, but a great name.
  • Homosexuality — yes, homosexuality was for many years regarded as a treatable mental illness. The bad news is this wasn't 100 years ago, where it might have been excused on the basis of ignorance — psychologists finally removed homosexuality from the roster of mental illnesses in 1975.
  • Recovered Memory Therapy, quickly followed by False Memory syndrome, after clients realized their therapists were talking them into bogus memories, often of horrid but imaginary sexual abuse at the hands of relatives, some of whom wound up in jail. In exasperation, many U.S. courts have ruled they will hear no more "Recovered Memory" cases and won't be throwing any more innocent people in jail.
  • Asperger syndrome — now abandoned, grouped with psychology's historical cast-offs, one of many conditions that everyone took seriously until the consequences became ridiculous.

The above are just examples drawn from a long list of conditions that have occupied the attention of psychologists and psychiatrists over the years, and Asperger's is only the most recent condition to join the roster. My point is that there are no "mental" conditions that stand the test of time — they are eventually either reclassified as physical illnesses with psychological symptoms, or abandoned.

Is psychology a branch of medicine?

As to the medical standing of psychology and psychiatry, these fields are not part of medicine, and there is no "mental doctor." Psychologists aren't classed alongside doctors and what they do is not medicine, primarily because they pay far too little attention to evidence. To restate an earlier point, because of the nature of the field, there are no "mental illnesses" (i.e. conditions originating solely in the mind, diagnosable and treatable using psychological methods) that have firm diagnoses on which equally qualified practitioners can agree, and there is no concept of a "cure". This explains why health insurers are reluctant to pay for psychological treatments.

A psychiatrist differs from a psychologist in that the former has a medical degree (in the U.S.), but a psychiatrist's medical training is separate from her psychological training — there is no true medical field called "psychiatry." It is commonly recognized that the psychiatrist specialty exists to give psychology an unearned status, and to confuse the public about the medical standing of psychology. When you call a psychiatrist "doctor," you're acknowledging her medical training, not her psychological training.

Do mental illnesses have the same status as medical illnesses?

This will not be true unless and until mental illnesses can be diagnosed objectively, in laboratory tests, rather than by opinion, until two practitioners with the same training can be expected to arrive at the same diagnosis (not remotely true now), and until there are meaningful treatments. I hasten to add there is no prospect for any of these outcomes, indeed as time passes the prospect declines further. Tom Widiger, who served as head of research for DSM-IV, says "There are lots of studies which show that clinicians diagnose most of their patients with one particular disorder and really don't systematically assess for other disorders. They have a bias in reference to the disorder that they are especially interested in treating and believe that most of their patients have."

The outlook isn't as dismal as this brief exposition might suggest. There is a medical field called "neuroscience" that studies the brain and nervous system and pays strict attention to evidence. Neuroscience hasn't accomplished much to date, but it has a promising future as a scientific approach to the treatment of physical illnesses having a psychological dimension. To readers who wonder how neuroscience differs from psychiatry and psychology, I offer this anecdote: While working as a research associate at Mount Sinai Medical School in New York City, during a conversation with a neuroscientist, I innocently used the word "mind." The scientist stopped me and said, "Please — don't use that word. It has no scientific standing."

To summarize this section, neither psychology nor psychiatry are part of mainstream medicine, and contrary to a carefully crafted impression, there are no clear causes, diagnoses or cures for "mental illnesses." Over time, conditions once thought to be "mental illnesses" have been either reclassified as physical illnesses with mental symptoms, or abandoned entirely. In the final analysis, the possibility exists that there are no true "mental illnesses" as that term is commonly defined — conditions reliably diagnosable and treatable using psychological methods.

Parental Responsibility

What should I do for my mentally ill children?

In modern times, for a parent to withhold needed medical care is not just irresponsible, it is illegal, and there are severe sanctions. In a recent news report, a mother was handed a long jail term for withholding cancer treatment from her son, who later died. I include this reference to make my readers aware that this is not a simple "just-so" story, understandable by anyone — modern society is in many ways a moral quagmire, where no matter what you do, someone will condemn you for it.

Parents have a social responsibility to get the best medical care for their children, and to pay attention to medical advances. As a result, partly because of confusion about the social standing of psychiatrists and psychologists, parents sometimes acquire nonsense psychological diagnoses for their children (or have such diagnoses forced on them by overzealous teachers, school adminstrators, and psychologists), confident that they're acting in the best interest of their children. Some parents are caught between a social requirement to pay attention to legitimate medical advances, and pressure from the mental health field to treat it as though it is part of medicine and deserves the same level of attention.

On this basis, I offer the following — if you are confronted by a mental health professional who claims your child is mentally ill, ask these questions:

  • "Is this diagnosis based on a blind medical procedure — a chemical or other technical test with no human intervention — or is it based on the opinion of an individual?"
  • "Can two or more mental health professionals be relied on to arrive at this same diagnosis?"
  • "Do we know what causes this condition?"
  • "Is there a treatment for this condition?"
  • "Is there a cure for this condition?"
  • "How long has this condition been included among mental illnesses?"

The above list seems to be a prudent list of inquiries, as true for mental health as it is for physical health. And guess what? There are no mental illnesses that survive the test — not one. If a person has one of the severe forms of schizophrenia, virtually all mental health professionals will agree on a diagnosis, but schizophrenia is not a mental illness — it's a physical illness with psychological symptoms. It's the same with bipolar syndrome and autism — these are physical illnesses, apparently rooted in genetics.

There's one more question I intentionally left out of the above list, and it's probably the most important one. Here it is: "If I accept this diagnosis for my child, in ten years will he be better off or worse off?" The reason this question is not in the above list is because virtually everyone in the mental health field will lie out of self-interest. Parents must ask this question for themselves, do their own research, and decide for themselves.

Consider these two reactions by a parent, speaking to a child who is "different:"

  • "I've been watching you over the past few weeks, and I see that you've started to really like collecting diffferent kinds of rocks, reading about them, classifying them. Some people have said you're getting a bit weird and spend too much time in this activity, too little with friends and more mundane activities. One teacher has suggested that you're suffering from a mental illness called 'Asperger syndrome', and that if you accept this diagnosis, you could receive special attention at school ...
    • "... So I looked into this, and it's true — the school gets more money, and you get more attention. Let's do it!"

    • "... But I think this might be a bad idea — there's no objective way to arrive at the diagnosis, there's no known cause, no treatment and no cure. Worse, if you accept the diagnosis, you might begin to think of yourself as privileged, or damaged, or both, and you might not work as hard as you must to succeed in the adult world. Remember that after school ends, having an Asperger's diagnosis can only work against you — you might be passed over for certain jobs because employers won't have high expectations for you, and worse, you might not have high expectations for yourself."

In conclusion, and in answer to the question "What should I do for my mentally ill children?", I have to ask:

  • What makes you think your children are mentally ill?
  • Will your children be better off, or worse off, as adults with the "mentally ill" label?
  • How many stock clerks became corporate executives after being labeled "mentally ill"?
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