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Sunday, November 3, 2013
Aspergers ... Brain / Mind ...

I’m not a psychologist or therapist, and I haven’t made much use of their services in my lifetime. But I still try to keep up with what goes on in “shrink world”, i.e. within the realm of the mind and brain, with the theories on how they work and the practices meant to help make them work better. From what I can see, one of the biggest fault lines and sources of tension in the whole field right now revolves around the old classic “nature versus nurture” issue. And it’s not just a dry, academic debate amidst the trained elite anymore; it’s becoming a matter of what the consumers of these services demand from shrink world.

For most of the time since Freud, psychotherapy and applied psychology has mostly involved talking; i.e. the good old “couch method” where the therapist and patient discuss what’s going on in the latter’s head, e.g. fears, compulsions, desires, frustrations, envy, attraction, etc. Sure, psychologists also perform some behavioral observation studies and surveys, plus they administer and analyze the results of standardized written tests as to gauge what is going on in the minds of their subjects. But for the most part, the whole thing revolves around Freud’s paradigm of “the talking cure”, i.e. a long-term interactive process through which the therapist figures out what the patient’s hang-ups are, and slowly directs the patient toward attitudes and behaviors meant to overcome negative, harmful patterns (neuroses), so as to develop healthy patterns that allow personal growth and positive achievement. At least that’s the theory.

In the past generation, talk therapy has become less and less prevalent; aside from public reservations, the insurance companies and government agencies that pay for most therapists’ professional fees have noticed that professional talking (“counseling”) is quite slow and expensive, even though it generally does benefit patients who complete it (studies indicate a fairly high therapy drop-out rate, between a third and a half of therapy patients voluntarily end their participation). Meanwhile, neurobiology and neuropsychology have made great advances in understanding the brain, mind and body processes that lay at the root of much (if not all) psychological dysfunction. In addition, medical doctors and specialists have developed more and more pharmaceutical interventions that help control the worst aspects of psychological behavioral dysfunction (psychopathic violence, extreme depression, hallucinations). Today, even the more mundane syndromes (common depression, anxiety, addictions) can be addressed with drugs. As such, the demand amidst potential consumers of psychotheraputical services seems more and more focused upon nature-based explanations for who they are, how they act, and what they think.

For the major mental and behavioral conditions like schizophenia and sociopathology, it has been clear and well accepted for a long time that deviant brain structures and processes involving hormones and neurotransmitters are at the core of the dysfunction. But for more run-of-the-mill conditions like shyness, social mis-adaptation, and common phobias, the emphasis was on using talk therapy to ferret out sub-conscious patterns that drive attitudes and behaviors causing unhappiness.

Why favor brain structure and process over sub-conscious “neuroses” that grow from short-term stresses but cause long-run unhappiness and disorientation? Because, it helps to see one’s own personal behavior a bit more respectfully; it moves away from the “you’re still hung up on something from your past” implication, and instead views personal behaviors more as alternative ways of being, i.e. just who you / I am. It allows more relativism and less judgment as to what social norms are or should be, i.e. what is to be considered “NORMal”, versus what is deviant or at least negative. What seems like neurosis to one person may be positive and creative to another. There are goods and bads to this trend.

The demand for and “trendiness” of an Aspergers Syndrome diagnosis (or self-diagnosis) in recent years is perhaps an example. Admittedly, it went too far; the top researchers, academic practitioners, and insurance companies responded with the Autism Spectrum concept to replace Aspergers. It was a way of kicking the many “slightly weird” and somewhat unusual people (like myself) off the boat, as to control insurance costs, and at the same time halt the move away from sub-conscious explanations (i.e. Freudian, even Jungian) and towards of inherent brain structures and processes. It helps insurance companies, but at the same time helps to put therapists back in control as the refuge for people who seem slightly weird or mal-adapted. I.e., don’t blame Asperger’s; if you’re not truly autistic, then it’s your own neurotic sub-conscious that needs fixing!

Let’s take a situation that I ran into about 20 years ago. I had been working for several years for a non-profit agency, where most of the staff got along quite well, including myself. One day, someone well-intentionally thought to plan a surprise birthday celebration for me (this office was really big on buying cakes and celebrating most any personal event possible — hardly a week went by without you being passed a paper plate of cake with plastic fork). I honestly didn’t see this coming; it truly was a surprise when I was called into a conference room for a meeting and opened the door to find about 20 people seated around a decorated table yelling out “SURPRISE” at me. It was a bit too much . . . I felt disoriented, overwhelmed, almost dizzy, somewhat in shock. And it wasn’t pleasant; for me it was something like having a camera flash go off right in your face. I actually walked back out the door and stood in the hallway, as to catch my breath and regain my composure. After 10 seconds or so, I went back inside and made a little joke of it, and we got on with the cake-eating. But everyone could tell that I really did not appreciate what had happened; they never had another surprise birthday party for me again.

Was my behavior in that situation a function of sub-conscious motivations, of attitudinal and behavior patterns rooted in some forgotten childhood experiences? (Most obviously, a putative bad experience with parents at a long-ago birthday party.) Or was it because of sensory processing dysfunction, sort of an emerging replacement for the role that pre-spectrum Aspergers was playing? Would I be better off with a therapist who might ask me “how old did you feel when that happened”? Or by an analysis of my tactile sensitivities, my physical coordination traits, and potential telltale adaptations such as embracing the mechanical / systematic things of the world for their reliability?

Obviously I favor the latter approach. A person favoring this “natural behavior for myself” viewpoint might also disdain the application of any drugs or therapies to change him or her — which the insurance companies surely will agree with! Although, such a person (including myself) might still want some level of analysis and therapy so as to help better understand one’s self, and thus help the self to grow in one’s own way. I.e., get out your Jung and update it a bit with cerebral wiring diagrams, chaos theory and neural networking cybernetics.

But of course, there are limits and dangers to this. A brain-processing focus can go too far; it can be a crutch to say “hey, that’s just how I was born, can’t do anything about it”. This trend could be abused by those who would argue that the world needs to respect my own peculiar ways and stop calling me neurotic, stop being so judgmental. Less social judgment might be good, but we still can’t respect the sexual preferences of child molesters and predatory pedophiles. Child pornography is still wrong, it’s not just an alternative expression of human physical desire.

And another possible side-effect and danger to those like me who do favor brain-condition analysis is the notion that any slight deviations from normal behavior (which I myself have plenty of) can be seen as “curable” through a therapy that changes how the brain works. Neuropsychology should not become the tool of the majority to re-wire anyone who is somehow different; only when there is clear suffering, significant loss or danger to others should drug therapies be imposed (or even recommended), subject to legal guidelines and protections. We need to respect the fact that weirdness and peculiarities are sometimes the breeding ground for creativity and (occasionally) genius.

Several months ago, I said in one of my posts that

there should still be room in a DSM for “Aspergers lite” or “Aspergers dynamic”, for “situational Aspergers”. Not so much as a diagnosis, not as a way to get government or insurance money, but more as a means for all of us to understand each other; and most importantly, to understand our own selves better.

Well, I don’t believe that DSM 5 does this. But as I mentioned, sensory processing disorder has been getting more public attention as an alternative to the “autism spectrum”. One web site Google herald says “it ‘s not autism — it’s sensory processing disorder”. I’m not an expert, but SPD does perhaps give some leeway for an “Aspergers lite” mechanism, in situations where children or adults do not suffer the multiple breakdowns that are implicated by autism, but still have some inherent mental differences that affect their behavior and socialization. (SPD is also excluded from DSM 5, but unlike Aspergers it is a relatively new candidate that arguably awaits further research and documentation.)

The ultimate goal, I would think, is to apply what is being learned about how the brain functions through “hard studies” in neurobiology, and apply this to the more common situations in daily life, to the human struggle to get by in the world, make some sense of it, and get along with one another. Up to now, this realm has been mostly the providence of the talk therapists. I’m not saying that classic psychotherapy should go the way of leech therapy, but it definitely should make a lot more room for inherent brain/mind differences. It needs to stop assuming that anyone with any sort of behavioral or relationship issues automatically hates at least one of his or her parents. Even thought I don’t like surprise parties, I liked my parents just fine!

◊   posted by Jim G @ 3:55 pm      

  1. Jim, I’m not sure how to “take hold” of your discussion here. In some ways I think you have some very good points; and in other ways I think you are throwing too much together in one basket, not allowing enough consideration for the varied problems the human race may have. (And by the way: I think you’ve left out the psychiatrist, a learned and profound scholar from Columbia University and Yale School of Medicine, who practices a therapy that is based on carry over into this present life of problems from former life times. He’s got some very interesting ideas [although I think his writing is repetitive and poorly done] that are hard to explain away and interesting in their own way. But I digress.)

    First of all, I think that for “major mental and behavioral conditions like schizophrenia and sociopathology” (as you mention them) I think that, in the end, not much can be done – except to protect the community from dangerous people. If these individuals who have such conditions are not dangerous, then I see no need to protect society. Why not just allow for strange people who think differently or want to live differently? In fact in some cultures at certain times such individuals have been honored almost as a God on earth, giving them serious respect in the community – certainly an interesting approach to “difference” in people. I think our society tends to want to make everybody be the same as everybody else, allowing for little deviation in personality or difference in people.

    Then too, I think there are a great many people who benefit from what is sometimes called the “talking method”. I do not think there is any doubt that, for *some* people, problems from childhood can be buried in their sub/unconscious, go unacknowledged for many years until they become such a problem in the individual’s life that help is sought. Often for such people, a gradual process that actually leads somewhere is useful, helpful, and often a saving grace. But that also does *not* mean that everyone can fit into that pattern.

    I also find myself wondering, even positing the evolution of the human race (i.e., the growth and development, not only of technology and “outside” types of things but a similar *internal* growth and development of the human being), wondering if an evolutionary process of the human person him/herself – might not also be at work in the psychological development of humanity, thus allowing for less “fitting into categories” and “more variation in the human being”; and here I am positing a positive and good growth and development and not something harmful and dangerous to other individuals or the community as a whole.

    As to the recent “update” of the DSM: From what I’ve read of the critique of that revision, it’s a mess, pure and simple. That’s a massive discussion in itself; so I’ll leave it at that. I might refer you to for a discussion sometime past of the DSM revision and for a sensible and thoughtful discussion of psychological issues, written by a retired psychiatrist who obviously has/had the help, health, and care of his patients as his primary goal; he seems a good man.

    Regarding depression: Here again, I think that there are many varieties of depression. At times it is appropriate for a person to be depressed, say, for one simple example, at the death of a loved one; if he/she is not depressed, it seems to me the person does not understand the situation. The appropriate response to such depression, as I see it, is *not* pills to get rid of such depression but the appropriate thing is to live through it, work through the depression, and come “out the other side”, so to say.

    On the other hand there most certainly are individuals who suffer from what I’ve heard described as “a massive dark cloud hanging over me all the time”; such persons would be helped by some kind of medication that may aid them through whatever lack of some hormone or brain chemical is missing (or in too much abundance) in their brain.

    As to the whole Asperger’s issue you mention as a problem you experience: It seems to me that your handling of the “surprise party” was very well done. But I’m not 100% sure that it is a problem related to Asperger’s. I for one *hate* parties and the ones I have been forced to attend in my lifetime have had me in misery for the most part. On the other hand there are individuals who *love* parties, thrive on them, are energized by them. Who is right? It seems to me that, once again, society is *insisting* that everybody conform to what has been (as you put it) the NORM. Why can’t *both* be “right”, just a difference in individuals.

    There seems to be something in society that brings everything back to the *me*. That is, if someone is not like “me”, then he/she must be “wrong” in some way; it could not possibly be “me” who is the one who is, let us say for lack of a better word, “odd”. Everything must come back to and conform to the “me”. I find myself wondering if there is an unconscious fear (OK, I said it – UNconscious fear) of the evolution of the human person. What change might come about if humanity itself changes; it may be change itself that is feared.

    In the end I tend to think that there is little room in our society for variation in persons – and right there is the problem. As long as people are not a danger to themselves or others, why not just leave them be who they are and enjoy the diversity, no matter how eccentric? I think such an approach would enrich and benefit people individually and collectively, rather than trying to fit everyone into a particular square or round hole of some kind. MCS

    P.S. These are my initial tho’ts on this topic.

    [JimG Comment: Mary, once again you take me to task on details, then in the final paragraph repeat and re-enforce my main point. But hey, that’s great! We both reach the same peak of the mountain, but I came via one path, while you came by a very different one. And yet, we wind up in the same place.]

    Comment by Mary — November 3, 2013 @ 8:18 pm

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