BOOK REVIEW: Asperger Syndrome and Anxiety by Nick Dubin. As I’ve said before on this blog, I have taken an interest in Asperger Syndrome over the past few years. A lot of what I read about Asperger sounds familiar. I’m not formally diagnosed, and I don’t fit all of the major characteristics that the typical “Aspie” is said to possess. But a lot of those characteristics do hit home with me, especially the characteristic of anxiety. Anxiety is indeed an issue in my life.

Well, you might want to respond here that anxiety is an issue in EVERYONE’S life. True, but Aspies have a special way with it. They (we?) have various mental techniques to create anxiety even when there is no rational justification for it. And of course, when there IS justification for being anxious, we take it to the max; we see doom and dark clouds in every little set-back. Obviously, that is not good for one’s health and well-being. It isn’t a pleasant way to live one’s life.

So, Dr. Nick Dubin, a recent doctorate in psychology and an Aspie himself, recently wrote a book about anxiety issues in the lives of adults with Asperger Syndrome. I recently read it, and overall I give it a “thumbs up”. Dr. Dubin subtitled this book “A Guide to Successful Stress Management”. In other words, this is not an academic study on why people with Aspergers seem to have anxiety issues, nor is it addressed to professional shrinks and therapists who treat Aspies. This book is aimed at the nervous adult like me who constantly struggles with “being different” from the crowd, thinking differently and seeing life thru different sunglasses. I wouldn’t necessarily call it a “self-help” or “do-it-yourself” book, as Dr. Dubin clearly urges readers to seek professional help. But he also provides much thought and many techniques that the typical Aspie can use to help control their own bouts of anxiety. Again, though, he does not promise that these alone will be enough; in fact, he clearly states that most Aspies can NOT take care of their anxiety issues alone, even if they faithfully apply what he lays out.

Just what does Nick Dubin lay out regarding Aspie anxiety? Mostly he provides a “talking cure”, or better said, a “thinking cure”. Under the banner of “cognitive behavioral therapy” or CBT for short, he explains logically why many Aspies feel apprehensive, and how they take this logic way too far, to the point of irrational fear and panic. Dr. Dubin prescribes a variety of “schemas” to show that “there’s not as much to fear” as the anxious Aspie thinks.

Basically, this is the faith of the psychotherapist; i.e., that an affective problem can be talked-through (at a cost of maybe $100 per hour). With enough talking (and enough $$$ to pay for all that talking with the shrink), the person suffering a psychological imbalance will see the light of reason and get themselves back together. I.e., they will get well. Dr. Dubin points out that there are anti-anxiety medications that a psychiatrist can prescribe, and that these do have their place. But, he concludes that “alleviating anxiety takes hard work; a pill alone won’t do it”. Obviously, that hard work involves lots of talking and thinking it over.

As such, it’s not surprising that Dr. Dubin does not at all mention in his book the growing research into brain structure factors that could contribute to heightened anxiety in people with Aspergers. Just a quick Google search will bring up a variety of information about neuron connectivity differences and lower-capacity connection structures between the limbic system (the emotional center of the brain, especially the amygdala) and the pre-frontal cortex (where most of the thinking and logic gets done). In other words, it IS possible that Aspies are fighting something that is partly genetic, something that is hard-wired in their brains. I.e., something that might require drug therapy to fully compensate, if the neurological problem can be fully understood and an appropriate medication devised and fully tested . That could be many years away; for now, the available anti-anxiety medications are relatively crude and un-targeted to the Aspie’s particular brain factors, and thus can be expected to have varying effectiveness along with negative side-effects.

Thus, at present there’s not much that the typical Aspie can do directly if in fact he or she is “wired up differently”. But I think it would have been good for Dr. Dubin to have included something about this, as it might help those of us dealing with the anxiety monster to feel a bit better about ourselves. Dr. Dubin devotes a whole chapter to “Anxiety and Shame” (chapter 9), and talks about “forgiving yourself” for having all these problems. Yes, I myself feel stupid sometimes for getting so wound up about little things. As such, I believe that it would help to know that a lot of the problem is not your fault, that it was locked-in genetically on the day that you were conceived.

By the same token, there is much temptation to take such information as a crutch, as an excuse not to try to get better. But Dr. Dubin makes a good case that “talking cures”, especially if done with a professional therapist, can be effective in helping Aspies to deal with anxiety (although he does not cite any effectiveness studies in that regard), and that self-forgiveness is a step in the process. In the context of his overall message, I feel that ignoring the neuro-structural factors relating to Aspergers Syndrome is regrettable.

If Dr. Dubin did miss one important aspect to understanding and dealing with anxiety in the life of an Aspie, he did not ignore another issue that is of major proportion: i.e., the question of SPIRITUALITY. Wow, imagine that — an acolyte of the great religion of psychology (and that’s what it ultimately is today, a religious faith system) admitting in effect that shrinks and their logic can only go so far!

Ya think?

Dubin thus includes an important chapter on “Anxiety and Spirituality” (i.e., Chapter 11). He tells us that although he was brought up in one of the major faith traditions, he is not today a practicing member of it. However, he has much regard for its spiritual wisdom, and seems to give some credence to the notion that “there’s something more” to reality than science and logic can explain. Or, at least BELIEVING that there is can help with the ultimate issue that we all face, i.e. death and dying. Obviously, scientific and quasi-scientific psychological logic are having their problems in helping people in this regard. Ultimately, all anxiety points to the issue of death. Most modern therapists and psychological researchers don’t want to admit this, as they don’t have a very good answer to it. (Freud would have done a lot better had he stuck to the death issue and not gotten so hung up on sex.) Dr. Dubin is to be commended for facing up to it.

Dr. Dubin’s approach to spirituality is a fairly typical modern mash of eastern wisdom and stretching some of the implications of modern scientific paradigms beyond their empirical boundaries (e.g., quantum weirdness, non-local quantum entanglement, ‘butterfly effects’ of chaos theory, and Dubin’s favorite, “morphogenetic fields”, which is based on X-file implications regarding certain strange events like monkeys across thousands of miles learning at the same time how to wash potatoes, or birds simultaneously learning how to remove caps from milk bottles. Coincidence? I don’t think so!). He doesn’t mention Ken Wilber, but that’s basically what we’re talking about. And yet, Dr. Dubin does tip his hat a bit to good old fashioned Judaism and Christianity. In sum, Dr. Dubin wants to help heal people, and he seems to recognize that modern psychology alone isn’t doing the job. So he’s willing to cross some lines and risk taking heat from the defenders of the “hard science” approach.

That is why I like this book so much. You can tell that Nick Dubin wrote it because he really wants to help others. There’s a warmth that comes through in his writing style. He shares a lot about himself throughout the book, including a discussion of the failures of his dating life to date (but he’s only 31, still has lots of time to get it together yet), and an interview with his parents regarding his childhood. He is willing to be vulnerable in order to get across some ideas that he believes will really help adult Aspies to deal with the many challenges in their lives. There are a lot of books out these days about Asperger Syndrome, some of which were written by people with Asperger Syndrome; but I can’t think of any Aspie books (and I’ve read a handful of them) that seem so warm and caring.

It is commonly believed that Aspies are robot-like geeks who lack empathy and are ultimately incapable of expressing emotion. And in person, a lot of Aspies come across that way; I know that I do at times. Perhaps Dr. Dubin is also like that face-to-face; I couldn’t say (but here’s a YouTube interview; he does seem a bit geeky). But down inside, many Aspies really DO care about others, even if they can’t always express it in the ways that society recognizes. Nick Dubin has shown that he does care, and has used this book to express it. That’s worth the price of the book alone. Even if his CBT techniques or schemas never do the reader any good, the anxious Aspie will feel better just knowing that Nick Dubin cares (and that it’s good for them to care for others too).

AB&C: Autism Bickering & Confusion. As someone with Aspergers Syndrome in my life (but not controlling my life), I have taken an interest in the various discussions going on in newspapers, magazines, books and on the web regarding this condition’s relationship to autism. As a whole, the field of psychology now classifies Aspergers as an “Autism Spectrum Disorder”. Researchers seem to feel that Aspies substantially share the same set of environmental and genetic circumstances that cause what some call “classic autism”, i.e. where the person cannot function independently and experiences severe learning and behavioral disabilities along with social deficits. According to the psychology “mainstream” view, the difference between an Aspie who is the president of a successful computer software company and an institutionalized adult with an IQ of 60 who can hardly speak, wears diapers and bangs his head at the wall, is mostly a matter of degree along this spectrum.

Admittedly, I am not qualified to give an authoritative answer on this. I don’t know anyone with classic autism, although a woman at work who sits a few cubicles away from me has an institutionalized 35 year old son with autism. I overhear many of the details of her relationship with him. I have read that the psychologists and neuroscientists are not unanimous about the “spectral view”; some see significant differences in the brain structures and environmental patterns of Aspies versus “classic autistics”. I do know from surfing the web that putting Aspergers in the “autism ship” has caused disagreements and bickering between parents with autistic children, advocates for research and therapy, and people who themselves claim to have either Aspergers or high-functioning autism. (Obviously, people who are “lower” on the spectrum cannot voice their thoughts on this).

If I’m getting it right, there are several camps. First, there are the Aspies who embrace the autistic categorization and call for what is called “neurodiversity”. This viewpoint in effect asserts that the world needs to give autistic people a break, i.e. be more open minded to their quirks and differences. It’s another variant of a civil rights movement. It says that autistics should not be looked at using a “pathological” model.

Next, there are the autistic advocates who argue against neurodiversity. It’s not that they don’t want Aspies to be welcomed and better understood by the public; it’s just that they feel that the Aspie crowd is stealing the political spotlight from them and their own needs. The Aspie crowd are the new kids on the block; whereas the relatives of classic autistics have lived in the proverbial neighborhood for a long time. They want more public funding for research and treatment for those suffering significant impairment from autism. They want a cure, not public sympathy. They realize that neurodiversity can happen on the cheap; genetic therapy for autistic infants cannot. One of the most noted proponents of this view is Len Schafer.

(Oh, there are also the “mercury people”, mostly parents of autistic children who want to believe, despite many scientific studies to the contrary, that autism is caused by mercury preservatives in vaccines. I won’t touch that one, since I don’t have children at all and certainly know nothing of what it would be like to have an autistic child.)

In response to Schafer and his like, some Aspie-neurodiversity people (e.g. Michael John Carley) have expressed sympathy (but not agreement) with those who want a cure for autism. The “old time autism” advocates nonetheless remain wary, convinced that all of the neurodiversity people are dead set against a cure for autism. The old-timers also seem to wonder whether Aspies would still care about low-functioning autistics once they receive their tokens of public recognition and acceptance.

There’s an interesting and related side effect from the increased attention that Aspergers Syndrome has drawn over the past few years. A lot of people have produced books, articles, web sites and videos proclaiming themselves to be Aspies and telling of their great relief now that they know “what’s wrong with them”, i.e. why they never seem to fit in with the world around them. Some of them have not been professionally diagnosed by a shrink. (Hey, I guess that includes me!). “Self DX-ing” is fairly common and generally accepted in the “Aspie community”. But there is a reaction brewing amidst the more cynical members of the public, i.e. that many self DX-ers (and even those with a shrink’s opinion) are often “slackers” and “whiners”. They’re just people looking for an excuse, just looking to justify their own failings. They just don’t want to do the work needed to be successful in this world. They’re almost as bad as the proverbial “welfare queens” of the inner city.

Interestingly, some of this reaction comes from those who clearly do suffer from “classical” autistic deficits or from those who take care of such people (e.g., parents). They send e-mails saying “you don’t have autism or Aspergers”. And in response, those accused of “slacking” publish their justifications, listing their autistic “credentials” and explaining how they’ve “paid their dues”. One interesting example is from a woman named Rudy Simone, a self-DX’d author of various books on AS. Ms. Simone recently put out a YouTube video presenting her own such ‘apologia’. Quite interesting.

As for me, here’s where I stand. I may well have Aspergers in my life, but Aspergers does not RUN my life. It could explain some things about me, but it doesn’t remove any of the responsibility that I will take for what has happened and for what is yet to happen in my life. I’m still at the wheel; I’ll take all of the blame and any of the praise (if there is any to be had from this skeptical world!). If anything, knowing about Aspergers and how it influenced my life gives me increased opportunity to use the rest of my life in a positive fashion. And it doesn’t take away any responsibility for what has already occurred. I can’t say that learning about Aspergers was a total surprise to me. My second grade teacher, Mrs. LaGreca, told both me and my parents that I was “different” (but not different enough to be put in special ed). Some older guys that I knew on the railroad back when I was 16 said just about the same thing. But they said that I had a “good difference”, i.e. I was more responsible and intelligent than most kids, if a bit weirder.

I am discussing Aspergers on my blog now, but I’m not asking for pity. I’m just putting out some thoughts that others might find interesting, and hopefully useful.

Next, as to whether I think that I myself should be considered “on the autistic spectrum”. Again, I’m not qualified to talk as a professional researcher or therapist. BUT, something about it doesn’t feel right to me. Perhaps there are genetic and environmental similaritie
s between me and my co-worker’s institutionalized son, which are of interest to the taxonomists within the psychological field. But in daily life, in the world of politics and laws and customs and social rituals – I think it’s a bad fit. Allison Singer also seems to have her doubts.

Perhaps this makes me a renegade from political correctness. If so, then so be it. I am not trying to throw shadows on those like my co-worker’s son. But given what my co-worker has gone through in her life, given all the angst she suffers regarding her son, I would love to see a cure for him. I am not afraid that the availability of such a cure would have hypothetically altered my life and my personality (especially since there probably will never be a true cure for a complex genetic condition like autism, just a number of ways to mitigate its more debilitating aspects; i.e., severe autistics might be made more like Aspies).

As to “neurodiversity rights” for those who have good minds but don’t have such good social sense; perhaps greater public awareness and acceptance would help. I realize that there are many Aspies who are living messed-up lives, people who can’t hold a job and can’t make friends or fall in love. I believe that our society should try to be kinder and gentler to everyone; I think there should be more understanding and compassion. BUT, I will admit that skepticism can also be healthy; people do get lazy and whiny sometimes, and need a little “cruel to be kind”. We do need standards. As with everything else in this world, it’s a question of finding the right balance. The whole Aspergers thing is a relatively new item on the public agenda, and it will indeed take a while to strike that balance.

But I think that balance will best be struck if Aspergers and neurodiversity is uncoupled from classic autism, and the “spectrum” is sent back to the ivory towers of psychological academia, from whence it sprung.