Category: All in the Mind

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All in the Mind

Who Needs Psychiatry?

Most human beings have undergone moments of emotional disturbance and have at times engaged in unwise and irrational behaviour due to inexperience, extreme stress or intoxication. Our unconscious may have created sensory illusions, echoes of past ordeals. Many of us have felt the need to withdraw, if only temporarily, in a world of our own. A sense of insecurity, guilt or just personal fascination can lead us to obsess with actions, issues or objects. We may even sink into a mire of introspective self-worthlessness, known to others as depression. In some of us these tendencies may prevent us from leading our lives in a way that others may consider normal or functional.

If somebody behaves in a dysfunctionally irrational way, there may be two kinds of explanations. The first, and intuitively most obvious, is that something out there, whether a recent occurrence or a distant childhood memory, has altered his or her state of mind. Alternatively the brain itself could be defective. It's not quite that simple because drugs, medicines and food can change our metabolism and alter our mood. More to the point our brains rewire in response to environmental changes, especially during our formative years, but by and large we may seek either psycho-social (also known as environmental) or neurological causes of our troubles. Neither psychology nor neurology can exist in isolation. The former deals with the software and the latter with the hardware, which unlike computer hardware, may be subject to a process of continuous adaptation known as neuroplasticity.

Some behaviours are not only subjectively dysfunctional or culturally inappropriate, but immoral and dangerous to the rest of the community, e.g. If a person became convinced that all red-haired men were evil and proceeded to murder all such individuals in his neighbourhood, it would be perfectly correct to detain the perpetrator and thus protect the wider community. Psychologists may wonder what traumatic events caused the murderer to commit these heinous acts and neurologists may wonder if his brain had an inherent defect or had been afflicted by a physiological disease.

A short definition of psychiatry would be the study of pathological behavioural patterns or according to the Free Online Dictionary, the branch of medicine that deals with the diagnosis, treatment, and prevention of mental and emotional disorders. A psychiatrist treats an aberrant behaviour as a disease. A complex of associated behaviours is then classified as a disorder. A psychiatric diagnosis is thus nothing more than a synopsis, albeit in erudite language, of observed symptoms, indeed the word clinical often preceding labels such as depression means just involving or based on direct observation of the patient. Surprisingly few people labelled with behavioural disorders have had their clinical diagnosis confirmed by PET or fMRI brain scans, but if any abnormalities were detected only an experienced neurologist would be able to make sense of the data. Nobody receives a psychiatric diagnosis based on the results of a brain scan and yet confusingly many victims of traumatic brain injuries and epilepsy manifesting conspicuous deficiencies in parts of the cerebral cortex allegedly responsible for reasoning and socialisation lead very successful lives free of psychotic episodes.

Psychoactive drugs rightly attract a great deal of controversy, but surely if they did help alleviate the worst symptoms of emotional distress and prevent extreme antisocial behaviours, the professional category responsible for their administration would be psycho-pharmacology.

Some see psychiatrists as the last line of defence when other law enforcement and social care professionals cannot deal with extremely abusive, dangerous or self-destructive behaviour. Psychiatry differs from psychology in defining aberrant behavioural patterns as endogenous diseases, which may have environmental triggers but are nonetheless inherent to the affected individual. Many parents and other close relatives go along with the psychiatric model because it absolves them of all responsibility. Schools, social services, police, state and corporate entities all tend towards psychiatric explanations for the same basic reason.

Don't Blame the Parents

This has long been the rallying cry of the burgeoning mental health industry, myriad charities, public and private sector institutions very much in the public limelight. Whenever anti-psychiatry raises its dissenting head, its advocates are vilified and often likened with Robert D Laing, and accused often in highly emotive language, of blaming parents. This misses three essential points:

  • Parents are only part of a child's environment and thus cannot be blamed for numerous other factors such as heightened social competition, mass consumerism, peer pressure, pervasive media etc.
  • Parents may themselves be victims of childhood neglect and adult stress, with a serious sense of inferiority, social alienation or addiction to hedonistic pursuits such as gambling.
  • If we stress the psycho-social causes of personal problems rather than endogenous biological causes, parents, and other close relatives and friends, have a greater role to play in rehabilitation. Many become depressed or experience psychotic episodes precisely because they lack full integration with their family and community. Even where neglectful or abusive parents are a large part of the problem, they may, except in the most extreme cases of abuse, be part of the solution.

So let's abolish psychiatry altogether. In some cases we may find answers in neuroscience, but in most we'd better take a good look at each other and wonder what we as individuals or as a society have done wrong to make an increasing number of us go insane.

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All in the Mind Power Dynamics

Managing Public Opinion

The Strange Case of Twelve Islamophobic Cartoons

Over the last week the publication of a cartoon portraying the prophet Mohamed as a terrorist has dominated the Western European media sparking a phoney debate about freedom of expression from the very people who misled us about the recent invasion of Iraq. On one side we have the ultra-PC brigade preaching the virtues of tolerance and feigning sympathy with the Islamic community. On the other we have a motley crew of Guardian-reading libertarians, a few even prepared to support the publication of the offending cartoon, others just defending the theoretical right to do so. While it may be reasonably argued that propaganda and disinformation can have murderous consequences, static cartoons hardly constitute the main causes of ethno-religious intolerance. Long before the appearance of this sketch Fox News, Sky News, the BBC and CNN had through slightly more subtle means persuaded millions that we face a growing terrorist threat from Islamic extremists. The Danish cartoon, assuming its author hailed from that land, merely caricatured mainstream US and UK propaganda, daring to portray graphically what journalists had refrained from stating explicitly.

As rights cannot exist without responsibilities, freedom of expression cannot thrive without a culture of mutual respect devoid of intimidation and emotional blackmail. It is quite possible to challenge orthodoxy on any subject in a cool, calm and collected way. If we believe either moral or scientific right is on our side, then surely any position is intellectually admissible. Whether sexual orientation is genetically determined is a matter of science. Whether some sexual orientations may be deemed immoral are matters of ethics that tend to evolve gradually and belong to a set of shared values. The trouble is sometimes scientific truth can alter our ethical worldview and our moral outlook can prejudice our interpretation of science. If it could be proven that genes more common in one ethnic group were responsible for antisocial behaviour, racists could cite science to justify discrimination, while others may seize on such data to redefine antisocial behaviour.

Sadly we don't live in a hypothetical Voltairean debating society where all personal perspectives are afforded equal opportunities of expression. Never has so much psychosocial power been vested in so few media organisations, controlled inevitably by a handful of corporate and state entities. They have the power to set the agenda, swing moods and whip up fear, almost unparalleled in history. One can give a totally misleading account of a situation simply by omitting or circumventing a few key facts, e.g. journalists may discuss the Iraqi election results without considering how much, if any, control the winning candidates will have over their country's resources. Broadcasters may also suggest the culpability of a whole ethno-religious group simply by showing scenes of jubilation in the aftermath of a brutal terrorist attack. Pundits may set the limits of permissible debate by misrepresenting unacceptable views and defining them as extremist, fundamentalist, dangerous or hateful.

Thus we are faced with a false debate. Should we support the publication of undeniably offensive picture and denounce Islamic fundamentalists burning the embassies of Scandinavian countries or should we join the chorus of media pundits urging further restrictions on free speech to protect our tolerant multiracial society? British politicians and newspapers can then be portrayed as beacons of common sense and moderation by their refusal to bow to either concocted extreme.

Intellectual freedom has never been the same as abstract freedom of expression. All viable societies have some form of social etiquette. A Finn would do well to cover himself appropriately when bathing at a public pool on holiday in Egypt. Likewise an Egyptian tourist should not complain if confronted with mixed gender nudity in a Finnish sauna. When in Rome... The Danish cartoon may incite little more than a chuckle from a reader sympathetic with the official UK/US line. Most are exposed to countless hours of gore, soft porn and slapstick comedy on TV, most of which is either fallacious or deeply prejudiced. Few British teenagers have seen the offending images, but millions have been exposed to countless hours of gratuitous interactive violence and a constant diet of self-righteous pro-war propaganda. Many may believe US and UK troops represent a force for progress in the Middle East, but prefer not to reconcile their rulers' military strategy with hard economic facts. Overt expressions of hatred usually backfire. They convince nobody, but those who have already been thoroughly brainwashed through years of insidious conditioning. Suppose I wanted to spoil the reputation of a colleague. Merely engaging in childish pranks that others could easily discover would only work in a climate of contempt for the targeted person. A more rational, and dare I say, common approach would be to discretely spread rumours or set a bait for your rival to rise to, while pretending all along to be his friend.

A widespread misconception is that power elites hate specific subsets of the population, whether ethnic groups, religions, classes, genders or followers of alternative lifestyles. In truth their sole concern is the maintenance of power and the stability of the infrastructure that keeps it in place. Historically ruling classes have engendered loyalty through nationalism and religion, affording privileges to sections of the working class whose affiliation suits their medium-term needs best. While many in the armed forces may have been conditioned to believe they are fighting for God, Queen and Country, the real elite owes no allegiance to an omnipresent deity or the citizens of their land and only rely on heads of states as temporary figureheads often representing long-superseded notional entities whose emotive importance lives on in the collective psyche. The emergence of supranationalism, often called globalisation, has changed the rules. While millions of ordinary British citizens perished in the industrial revolution and conquest of new lands, they were nonetheless afforded privileged status over rival ethnicities. As the British population grew rapidly, their rulers could offer them plenty of new terrain to exploit and tap resources from the colonies. Subgroups with an incomplete allegiance to the great imperial project, such as the Irish, were often disadvantaged, but the ruling class merely exploited their subjects as vanguard forces in a long-term project of global domination.

So why should the elite care if we subscribe to traditional Islamic values or the liberal values of 1970s Western Europe? Do they mind if we worship pop idols or Mohamed or if we believe homosexuality is a positively cool genetic trait or a deviant behaviour? The truth is they don't care, but are quite happy to manipulate our strongly held views on these subjects to destabilise society and frighten us into accepting yet more control over our lives. The same forces that have consistently destabilised the Middle East to secure control of oil there, also manipulate our attitude to Islam, by promoting migration and pendantic political correctness, and simultaneously incite anti-Western feeling in much of Islamic world. The dark forces of the military-industrial complex that would dearly like to seize control of Iranian oil and gas reserves before China gets its greedy hands on too much of it must be rejoicing at scenes of enraged Middle Easterners burning the embassies of Scandinavian countries. First it deflects attention from the true centres of imperial power and second it focuses attention on a peripheral issue of purely emotional significance. Would you rather your neighbour make the odd rude joke about your lifestyle or greet you politely every day while plotting to have you evicted, made redundant and tortured?

People throughout the Islamic world have every right to boycott Western good to express their anger about Western imperialism, but why target Danish, Norwegian and French goods? Why not target US and UK banks?

This whole debacle is above all a media event. The original series of a dozen cartoons appeared in September 2005, but the story only exploded onto the international scene in January 2006. Surely some Muslims living in Denmark would have been alerted to its existence, but apparently initial reactions were muted. Just as Jack Straw can claim the moral high ground by voicing his disapproval of the cartoons, other pundits can join the chorus condemning flag-burning Islamic fundamentalists, with apparently nobody caring who controls resources in their countries. Presumably it's okay for London's Metropolitan Police to shoot dead a Brazilian electrician suspected of being an Islamic terrorist. It's fine to detain without evidence British citizens suspected of sympathising with alleged terrorists. It's also perfectly normal to spend hours every day immersed in a virtual world of gun battles. But if one breaks absurd rules of political correctness, whether defined as Islamophobia or homophobia, then one can only expect instant police action and mass demonstrations orchestrated by media barons.

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All in the Mind

Today’s Hate Hour

"Today we're dedicating our hate hour to an evil man, suffering from a chronic psychopathic sexual disorder. He deserves only contempt and should bury himself under the nearest rock. This man was caught viewing paedophiliac images on the Internet. We don't have any evidence linking him to real-life sex crimes, but are in no doubt that anyone casting their malevolent eyes on images deemed paedophiliac will sooner or later commit such a crime. It is imperative that we apply the preventive principle to avert any repetition of the Soham murders. Indeed as a precaution all teachers who have not been certified as "non-paedophliac" should be witch-hunted out of schools."

This is more or less the tone of media coverage over the Paul Reeve case. As soon as the key terms "child pornography" and "Internet" are mentioned in the same breath, we suspend critical analysis. These key words represent the ultimate evil and any measures, however draconian, should be taken to protect our children from sad depressed lonesome weirdoes glaring at pixelated renditions of underage sex. How could anyone sink to such extremes of depravity and how could anyone forgive such perverts? These are questions we are asked to address.

No doubt in the coming weeks Channel 4's hate season will feature a documentary on a purported paedophile gene, causing some chemical imbalance and remedied by a new variant of Risperidone or Zyprexa. Next we'll hear calls for early intervention. I've already seen posters depicting a teenage male baby sitter and a caption suggesting he's a paedophile. Maybe some of your neighbours are closet paedophiles. Go on, spy on your neighbours, you know just in case!

Then the omnipresence of depravity dawned on me. If child pornography is such a unique evil (and definitions please, lest the police sequestrate photographs of my three year-old daughter playing on the beach), then why not arrest the director general of Channel 5? In depressed moments late at night I have occasionally briefly switched over to this channel, now available to most TV sets in the UK. My random sample would indicate a certain obsession with documentaries on the porn industry including footage of a famous North American porn star claimed to be under 16. Next why not arrest the owners of Wanadoo Internet or the predecessors Freeserve? When I had an account with this ISP and was stupid enough to use Outlook Express with inline images enabled (I've since switched to Firefox and Thunderbird on Linux with most spam pre-filtered into my online spam folder), I was deluged with spam. First it was Prozac, then Viagra spelt in numerous creative combinations of comparable characters, then adult sites, farmyard sex and worse, which I personally find exceedingly distasteful. I tried to delete these unwanted HTML-enhanced e-mails, but often images would briefly appear on my screen. These bitmaps are actually stored in your temporary Internet cache, even if you delete them straight away. I used filters and disabled images, but eventually dumped Freeserve, frustrated that some genuine e-mails had been blocked. Many porn sites can be accessed within two clicks from many high-profile news and sports sites. Just click on any link to a gambling site and chances are it will sport a link to an adult site, which in turn will cater for all tastes, mature, hetero, homo, bi, teen and early-teen and not quite teen yet. With all the media outrage over kiddie porn you'd expect the government to clamp down on the porn industry, but that's not quite the case. In 2004 the UK government granted its friends in the entertainment business licences for the provision of adult content, a euphemism for hardcore anal, oral and multiple-orifice frollicking, on 3G phones and terrestrial digital TV.

That child sex abuse can have severe long-term psychological implications is beyond dispute. It seem a bitter irony that the same establishment promotes the bio-genetic model for personality disorders like schizophrenia rather than looking at environmental factors closer to home, despite a wealth of evidence linking child abuse in various guises with psychosis later in life. But there must be a distinction between gaining pleasure from viewing or interacting with virtual reproductions of depravity and committing such acts. I'd argue that exposure to media trivialising or desensitising us to various forms of depravity, be it sexual abuse or physical harm, does make us more likely to commit such acts in real life, but only if we are otherwise psychologically unstable and believe we can get away with it, i.e. there are no counteracting social forces. Thus it is argued that people can play first-person shooters six hours a day, but never dream of killing in real life. This begs the question as to why such games need to feature blood-soaked murder, rather than other pursuits that test your hand-eye co-ordination and strategic skills. If you like target-practice, you need not fantasise targeting a human being, you can play darts instead.

Likewise one can consume large quantities of porn, of dubious taste and realism, perfectly legally. Rape of over 16 year-olds is still, as far as I can tell, a crime in this country. I suppose rape of an under-16 year-old is a more severe crime, but rape of anyone is a crime nonetheless. Besides promoting the notion that anyone not particpating recreational sex at least twice a week is erotically deprived in need of more partners, sex toys or drugs, the media encourages everyone, especially women, to flirt proactively and be obsessed with their body image so they attract the right calibre of partners. So what happens if someone fails in the shagging race and cannot control his libido, but is exposed to perfectly legal media telling him both gang bangs and first-person shooting are positively cool. So if kiddie porn promotes child abuse, then all pornography promotes rape. And if you think all legal pornography portrays acts between consenting adults, think again! Much shows re-enactments of unrequested penetration with the victim first repelling her assailant and then revelling in it.

We are supposed to believe that someone who has not only been cautioned by Police for the crime of viewing a depravity and admitted such a caution to his employers, would overstep the mark by abusing his position as a PE teacher by actually fondling teenage students in a sexual way! Suppose Mr Reeve had been a Manhunt addict instead, would he want to kill his students? I don't think the grotesque violence portrayed in Manhunt would help stabilise any psychological weaknesses he may have had, but 99.9% of teachers would be in no doubt what constitutes immoral behaviour in a changing room and most enlightened enough to realise that nudity is not, per se, sexual. The harsh reality is that it's getting harder to recruit teachers who can deal with the level of intimidation and defiance exhibited by many students in UK secondary schools and teachers are increasingly targets of false accusations. Indeed in some cases the alleged victims, and we're talking about 14 and 15 year-old girls here, have taken the initiative on male teachers on whom they have a crush, encouraged by gossip in girly mags, peer pressure and fantasies of wealthy boyfriends.

Anyway I'm off to the police to hand myself in as a potential serial killer for having endured "The Terminator II" during a long-distance bus journey. I will then ask to be placed on the sex offenders' register for having viewed multiple-orifice copulations in Playboy at the tender age of 14. I haven't raped or killed anyone yet, but you know just in case!

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All in the Mind

The Arbitrary Extension of the Autistic Spectrum

Over the last twenty years we have witnessed a semantic shift in the concepts of autism and the wider autistic spectrum. The former may assume three broad definitions:

  1. A mental condition devoid of a theory of mind with which to relate to other human beings. In this sense we all start life in an autistic state and gradually develop progressively more advanced theories of mind. Early attachment with one's primary care-giver and bonding with real-world friends clearly play a crucial role. However, alienation, severe depression and other traumatic events may cause individuals to regress to a more autistic state.
  2. A severe pervasive communication disorder affecting the early progress of key developmental milestones, in which an individual fails to empathise with or respond emotionally to other human beings as members of the same species or community. It is accompanied by a severe intellectual handicap in 70% to 80% of cases. This kind of classic Kanner's autism affects a very small minority of children. However, recently we have seen a rise in regressive autism, in which children develop normally for the first 24 to 48 months and then regress into an autistic state (as per definition 1). In some cases regression has been known to occur at even later stages, however, it is reasonable to conclude that such a deterioration in a person's emotional and social intelligence stems from an underlying neurobiological abnormality. Even if we include the latter group the percentage, according to statistics furnished by the National Autistic Society, of people with high-functioning or low-functioning autism does not exceed 0.2% of the UK population. This is admittedly higher than official autism rates in many other European countries, but individuals with such severe impairments would be classified as in some way learning disabled in all countries with advanced health and social services.
  3. A pervasive personality disorder affecting socialising patterns often accompanied by obsessive interest in a narrow range of circumscribed subjects, relative lack of empathy, relatively poor soft skills, tendency to work alone rather than as a team player, lack of expressiveness in one's body language, idiosyncratic mannerisms, depression, hypersensitivity to sensory inputs etc.. This spectrum usually includes Asperger's Syndrome and Semantic Pragmatic Disorder, but is often extended to include even vaguer labels such as ADHD, Tourettes, Social Anxiety Disorder and schizophrenia. We cannot ignore the conspicuous fact that numerous individuals have been diagnosed with two or more of these labels at different times in their lives. Unlike autistics as per definition 2 people in this category have all reached essential developmental milestones within the normal range. They are thinking, talking, emotionally responsive human beings whose behavioural traits blend into the mainstream. Indeed many question whether the behavioural traits associated with these labels should be considered in any way pathological, and thus worthy of treatment, at all.

As someone who has been diagnosed with AS myself, I know from personal experience that the psychological problems that lead affected individuals or their close relatives to seek diagnosis are very real. Many live very isolated lives coping with long-term unemployment and extreme social alienation. Any caring society should reach out to such vulnerable people. However, the growing autism and Asperger's support sector is unanimous in concluding that:

  1. People with personality disorders as per definition 3 belong to the newfangled autistic spectrum.
  2. The underlying cause of their problems is neurobiological, i.e. They have different brains.

These assertions are recycled in countless books, magazine articles, medical abstracts and Web sites, despite the fact hardly any of the 380,000 (according to NAS statistics) people diagnosed with AS have ever had a PET or fMRI scan. The evidence cited to support the theory that AS-individuals have a clearly identifiable brain structure different from that of so-called neurotypicals is at best fragmentary and inconsistent, but more important refers in most cases to genuine autistics (HFA or LFA). They also fail to explain how some individuals have recovered emotionally and socially from severe traumatic brain injuries or account for the latest research into the emerging field of neuroplasticity, which shows how the frontal cortex regularly rewires itself in response to environmental stimuli. Thus it should not surprise us if individuals with a given set of behavioural traits yield analogous activation patterns in the orbito-frontal cortex during an fMRI scan, as results for the same individual have been shown to vary in response to mood and recent personal experiences.

Heterogeneity of AS-diagnosed Individuals

Before we can generalise the behavioural or alleged neurological differences associated with Asperger's individuals, we need to ask whether they form a homogeneous group in any meaningful sense. Most affected individuals are diagnosed on the basis of clinical observation. I know of one specific instance in which an individual was diagnosed after a single one-hour session. Increasingly diagnosticians consider AS to be the high-end of the autistic spectrum, so a sizable number of individuals, who would previously be labelled as HFA or regressive autistics, are labelled AS because they can talk.

Misdiagnosis: The Case of Joe

As a community support worker in a project aiming to provide individuals with a learning disability with some work experience, I came into contact with a young man, who I will call Joe to respect his confidentiality. At the time I had recently been diagnosed with AS myself and was particularly keen to develop a rapport with Joe. His speech was limited and greatly simplified, he seemed relatively oblivious to conversations going on around him, his expressions of key social concepts were extremely simplified (e.g. “My dad builds bad houses†meant "my father is an architect whose work may have been criticised"). Admittedly he had islets of ability, notably in trains and aeroplanes, but at the age of 23 was for all intents and purposes illiterate and despite the best efforts of numerous special education teachers and social workers he had only very basic numeracy. He could, however, perform some tasks, such as working a badge-making machine, extremely well and had showed interest in sealife and dry-stone dyking. However, sometimes his support workers would mislead others by overstating his abilities, e.g. He had attended an electronics course at a local college and had learned to solder components onto a printed circuit board, but had no idea of the functions and relationships of the components. His masterpiece exhibited by an eager support worker was little more than a plastic board with a neat artistically arranged pattern of transistors and resistors. Joe required 24 hour support and showed no interest at all in socialising with or even remembering the names of colleagues. How could such a person be diagnosed with AS and placed in the same category as nerdish university professors or sufferers of social anxiety?

I later learned more of Joe's background. He had apparently regressed rapidly from the age of seven and had suffered repeated epileptic convulsions as a teenager. For many years he would not talk at all. I know nothing of his medical history, but it is to be assumed that he had been administered barbiturates and benzodiazepines with side effects known to induce severe retardation.

It is thus quite possible to select a group of AS-diagnosed individuals with severe emotional deficits for fMRI screening and then conclude, erroneously IMHO, that others with apparently less severe symptoms, conform to the same neurological pattern.

Two Very Different Phenomena

I believe we are faced with two very different phenomena, whose similarities are only apparent on the basis of cursory clinical observation.

  1. Neurobiological autism, i.e. Caused by a fundamental brain abnormality. It should be stressed that there is an enormous variation within this group and many genuine autistics are not only talented, but have progressed to write books and lead successful careers (Donna Williams and Temple Grandin come to mind). Also as the onset of autistic behaviour varies considerably there are likely to be many subgroups with different aetiologies, e.g. regressive or late onset autistics are less likely to have an inherent genetic defect.
  2. Psychological disturbance of culturally defined normal emotional and social development: This encompasses by far the largest group of people classified within the broad autistic spectrum. The associated idiosyncratic behavioural traits, labelled autistic, AS, ADHD etc.., result from a complex interaction with environmental, somatic and psychological influences.

Possible Causes of Psychological Asperger's

For want of a better term I will stick with the label Asperger's, a loose term for people exhibiting the behavioural traits outlined in the DSM-IV. At this stage it should be noted that the Diagnostic and Statistical Manual is a publication of the American Psychiatric Association, but is a common reference in a number of other countries, notably the Anglo-Saxon World (UK, Ireland, Canada, Australia, New Zealand) and regions with close to the Anglo-Saxon model such as Scandinavia. AS entered the DSM at the same time as ADHD and diagnosis only became common in the mid to late 1990s following considerable media exposure by various advocacy groups. Many psychologists have already questioned the validity of ADHD as a psychiatric label. Others have long challenged the very concept or neurobiological origins of schizophrenia or more recent constructs such as bipolar disorder. AS-diagnosed individuals cover a wide spectrum of behavioural traits that clearly overlap with those associated with other psychiatric labels.

It is important to distinguish somatic and minor neurological adaptation that may affect an individual's sensory perception or relative ability to perform complex tasks such as playing ball games, dancing or multitasking in an environment with conflicting sensory input on one hand, from fundamental neurological difference that completely inhibit a person's ability to form relationships, communicate or relate to other people in a characteristically human way. E.g. Many visually impaired people suffer forms of social alienation, but nobody would suggest that blindness in itself stops people from forming meaningful human relationships or causes clinical depression. The latter symptoms arise because normal social interaction is inhibited by a sensory impairment. Likewise a person who has suffered severe facial burns is expected to take time to adapt psychologically to people's duplicitous reactions to their disfigurement. As long as these differences are clearly identifiable and labelled as disabilities, other people can learn to compensate and often overcompensate.

  1. Dyspraxia:Many, but by no means all, AS-diagnosed people have various degrees of dyspraxia, namely a deficiency in hand-eye co-ordination, a slightly delayed reaction time or just plain clumsiness. This is likely to have a neurobiological basis. As a child I tried to join in football games, but simply kept missing the ball. At the time I put this down to a weak left eye, but obviously some people have better fine-motor co-ordination than others in the same way as some are more musically talented than others, but we'd only define people with a severe motor impairment as in any way disabled. Also only a minority of dyspraxics would meet the diagnostic criteria for AS. We may merely state that there is a relatively high correlation between dyspraxia and AS. Dyspraxia affects our ability to participate fully culturally important pursuits such as ball games and dancing, making us appear uncool and choose other more individual pursuits, isolating ourselves from a key part of mainstream social life and depriving us of opportunities to learn team-playing techniques so important in today's socially competitive society.
  2. Minor Disfigurements: Many AS-diagnosed people have minor aesthetic disfigurements, severe teenage acne, eating disorders etc.. IMHO AS-like behavioural traits often develop as a reaction to social rejection or an inferiority complex.
  3. Cultural Mismatch: A very large proportion of the AS-diagnosed individuals I have met are in some way culturally mismatched, i.e. come from a family background somehow out of tune with the prevailing culture in their neighbourhood or school. Of fifteen adults who regularly attend the Edinburgh group, at least two attended private schools and thus have atypical accents for their locale, three (including myself) moved to the area recently from elsewhere in the UK, one moved from Germany and was diagnosed here (and seems intent on converting some of us to his brand of Christianity), most of the rest come from middle class backgrounds. Indeed I'd say only 3 or 4 come from ordinary working class backgrounds at all, who incidentally tend to be the least vocal at meetings. IMHO AS-like behavioural traits tend to develop as a reaction to cultural alienation in the absence of a strong sense of community. This may explain why relatively few members of non-white ethnic minorities have been diagnosed with AS. I have come into a contact with a Hong-Kong born, ethnically Chinese, young man diagnosed with AS, but his cultural affiliation is most definitely Anglo-American.
  4. Modern Lifestyle: AS-like behaviour is only identifiable in regions that have adopted a high-consumption economic model in which most people are employed in the tertiary sector with a prolonged adolescence and a high percentage of young adults attending further education. In regions where most people are involved in the primary or secondary sectors (farming or extraction and crafts or production) the relative social handicaps associated with AS are neither apparent nor considered pathological. Some people are considered to have different characters with different relative strengths and weaknesses. We cannot ignore the psychological effects of radical cultural changes in the space of a few generations. Only a generation ago, the whole media universe (TV, video-games, computers, mobile phones etc.) played a relatively peripheral role in the development of imagination, creative play and social relationships. The diagnosis of a new series of personality disorders in children and adolescents has coincided with a significant rise in exposure to a virtual world of electronic media and a breakdown in traditional family life.

Often these factors coexist or become self-perpetuating, e.g. Someone with a very low sense of self-esteem as a result of a cultural mismatch or relatively mild form of dyspraxia may not care much about personal appearance and hygiene and is more likely to adopt a couch potato lifestyle, with resulting eating disorders, obesity, acne etc.., for fear of rejection in the real world. Among the many secondary traits associated with AS, an Edinburgh-based autism consultant stressed sleeping disorders, yet failed to mention that insomnia has huge cultural variables. It seems obvious that sleeping patterns would be disrupted by long-term unemployment and addiction to television, computers and video-games. Also conspicuously absent from her speech was the fact that a known side effect of the medication prescribed to sufferers of AS, chiefly Prozac, Effexor and Paxil, is insomnia. The same can be said of the steady gaze considered characteristic of AS.

The Psychiatric Establishment and the Learning Disability Agenda

First let us distinguish three concepts:

  1. Neurologically determined intellectual impairment: This is commonly known as a learning disability and replaces mental retardation and mental handicap. While there are certainly many borderline cases, and undoubtedly many of cases of regression, this infers a fundamental and irreversible cerebral abnormality and should not be confused with low personal achievement due to environmental and psychological factors.
  2. Severe psychopathic personality disorders: Whatever the causes, the behaviour of some individuals is clearly antisocial. We need to examine why there has been a concomitant relaxation of the criteria used for such disorders and a rise in the number of depressed or socially alienated people seeking some form of psychological help or referred by others to psychiatrists. Although definitions vary considerably, psychopaths are thankfully a relatively marginal phenomenon. Most people would only kill under extreme duress or after prolonged operant conditioning, e.g. army training.
  3. Psychological problems aka mental health problems . These affect us all to varying degrees at some time in our life.

First it is my opinion that the first category only applies to a very select group of individuals who need our help. Second the emergence of the autistic spectrum concept has enabled a considerable blurring of these categories both in the public mind and more disturbingly among psychologists. Most of the literature about Asperger's Syndrome emphasises that affected individuals lie in the normal to high IQ range. However, most people referred to the NHS psychologist who diagnosed me had some form of learning disability, i.e. an IQ < 70. This term means different things to different people, e.g. it may apply to dyslexics with above-average IQ's. It is commonly confused with learning difficulty, e.g. A child with a mild visual impairment has a learning difficulty because she might need to sit closer to the blackboard or need reading books with extra large print. Clearly the PR machine of the autism sector emphasises that AS means autism without a learning disability, but the psychiatric establishment thinks otherwise. It classifies AS as a form of social blindness that severely impairs an individual's ability to interact responsibly in a social environment. It thus follows that to protect an AS-diagnosed individual from the consequences of his own actions, he needs special help and support, often a euphemism for control.

Again the autism sector seldom mentions schizophrenia or bipolar disorders, while the psychiatric establishment, with whom the former collaborates very closely (with individuals moving from one sector to the other), considers schizophrenia either as part of the autistic spectrum (cf. Lorna Wing) or at least closely related. There have been a few high profile cases of young men diagnosed with AS who have committed heinous acts. In one recent case a teenager murdered the daughter of two of his parent's closest friends. In another a man murdered his wife because he suspected her of having an affair with a colleague. The inference is thus that AS individuals, though usually just a little eccentric, are particularly prone to psychopathic behaviour and thus need more help and support before they contemplate such acts. By failing to distinguish the vague concept of “people who some psychiatrist has labelled with AS†with the more psychologically valid concept of “people who manifest a clearly identifiable set of behavioural traitsâ€, we are being lulled into accepting a huge expansion of the autism/AS sector and through the backdoor, of the psychiatric establishment. This latter aspect should be of particular concern to us in view of new legislation for compulsory screening for personality disorders and mental health problems in the United States.

Next we need to ask who this sector is really helping? As previously outlined, I know of two organisations in Edinburgh (Autism Initiatives and IntoWork) who have incredibly low staff/client ratios. IntoWork helps people on the spectrum find a job. Based on their performance so far (and I know many of their staff and clients), it would make more economic sense to use the funds allocated to this organisation to artificially create jobs for their clients. The autism sector keeps stressing the need for advice and information. I ask what use is incorrect, inconsistent and/or scientifically unproven information? What advice can a trained autism advisor give that many other socially aware volunteers could not give? In the end what each individual needs is a chance to meet new people, form friendships, complete education and get meaningful and adequately well-paid employment. Often the setting up of various “Asperger support groups†only ghettoises individuals who are already both vulnerable and isolated. All too often they are recruited to raise autism awareness (spread the message), thereby advancing the careers of their support workers.

Explaining the Enigma

The Asperger's enigma cannot be understood in isolation. If we believe that Aspies have radically different brain structures, then the psychiatric establishment may have a point. The real evidence on the ground I've seen so far shows clearly that the AS-diagnosed form such a heterogeneous group with such a wide variety of personalities and behavioural traits that any attempt to map their brains and identify neurological patterns would prove meaningless. Even a cursory look at available research reveals conspicuous inconsistencies with many themes common to the identification of other psychiatric labels or mental health problems, .e.g. It is extremely doubtful that relative serotonin levels could explain autism, yet leading autism experts such as Richard Howlin recycle such notions.

If over the next few years we witness a further proliferation of new personality disorders, I feel we should be extremely sceptical at the real agenda behind this movement. Also note that estimates for the incidence of AS, SPD, Tourettes, ADHD and Schizophrenia vary considerably. In some school catchment areas in the incidence of ADHD has already reached 1 in 5, in others it barely figures. Likewise some statistics suggest as many as 1 in 100 people have been diagnosed with AS or other related conditions, but many autism advisors suggest the figure is much higher. Again the same NHS autism co-ordinator, has publicly stated that as many as 10% of adults have AS. Where do they get these statistics from? Yes, a very high fraction of people share to varying degrees some of the traits outlined in DSM-IV, but what exactly does that prove if hardly a single trait is mandatory for diagnosis?

Do all aspies freak out in the presence of bright lights and loud noises ?
Apparently not I have met an aspie in Edinburgh who loves discos and noisy pubs and incidentally has no special interests to speak of, just a record of antisocial behaviour and joblessness.
Are all aspies blind to subtle facial expressions?
Again this varies a good deal, I'd say only relatively so and in some cases not at all?
Are all aspies loners by choice?
In my experience this is rarely the case, most actively seek friendships and become depressed precisely because of their social failings?
Are all aspies unaware of social etiquette or other people's feelings?
Only in so far that many are so depressed or alienated that they cannot identify with their peers, but given the chance most will soon develop empathy, especially for other like-labelled individuals.
Are all aspies scared of travelling to new locations?
Some are relatively stay-at-home types, but many I've met are intrepid travellers who would just like a companion.
Are aspies anticonformist?
Some are, but then some are positively conformist, often turning into faithful recruits to new causes, such as autism awareness.
Why do so many apsies think they belong to the autistic spectrum?
Because they have been taught so and failure to extend solidarity to a small minority of genuine autistics is simply politically incorrect. For many aspies autism simply defines their true selves. Some even talk of my autism as if it were a cherished attribute or possession. Some will celebrate autism as a positive trait and liken their struggle against discrimination to that of ethnic minorities. However, while we should all oppose discrimination against people with different personalities, the analogy with racism ends there. First people of black African descent form a clearly identifiable ethnic subset of the human species. Second no self-respecting black rights activist would campaign for "biologically inferior wogs" to be provided more help and support to overcome the natural superiority of the master race. They rightly challenge all claims of racial superiority and point to the socio-environmental causes, the legacy of slavery and imperialism, of their comparative lack of achievement in multicultural countries like the United States. Being focused, intellectual, frank or even hypersensitive to sensory disturbances are all great qualities. What is wrong is a society that labels such traits as pathological.

The problems faced by most people diagnosed with Asperger's Syndrome will not be solved until we remove confusing psychiatric labels and dissociate culturally mediated personality traits from cases of severe intellectual impairment or severe communication disorders. We need to look at our society, not at biomedical solutions to personal problems.

Categories
All in the Mind

We Care about those who disagree

Samantha Stasy is a loyal Labour MP who genuinely cares about the physical, emotional and mental wellbeing of her constituents. Every week she holds a surgery providing local electors with a forum in which to air their grievances. "I believe it is essential to stay in touch with our electors, listen carefully and help them overcome their problems or refer them to professionals who can."

Samantha: "Hello, Mrs Contrary, I've read your e-mail, taken on board all your comments and fully sympathise with your predicament."

Mary Contrary: "Let me explain my disagreements with your government and your voting record."

Samantha: "I'd love to discuss the hard decisions that we as politicians have to take and fully respect your opinions, but I think I know where you're coming from. I joined CND as a student myself back in the 1980s, attended a few SWP meetings and went on my fair share of demos. At the time I genuinely believed in the righteousness of the cause, but with help and support over the years I've begun to see the error of my ways."

Mary Contrary: "Don't you think that voting for an invasion that has caused at least 100,000 deaths and was as any rational analyst would conclude motivated by oil is one mistake too far?"

Samantha: "I must say conspiracy theories are getting wilder these days. I voted to end a brutal dictatorship and allow the Iraqi people to benefit from the democracy we take for granted."

Mary Contrary: "What about oil?"

Samantha: "This seems to be a common theme among the antiwar brigade. Yes, we hope that the Iraqi oil industry can return to its previous levels of efficiency in line with international environmental regulations, and are putting in place an economic framework in which ordinary Iraqis can benefit from resources in their own land."

Mary Contrary: "Ms Stasy. I don't need to hear this nonsense. You know all oil proceeds pay off debts that Iraq built up in the 1980s and in practice go straight into the coffers of US and Israeli multinationals with lucrative reconstruction contracts."

Samantha pauses to take notes 'Patient may suffer from mild form of antisemitism, consider holocaust awarenesss training'.

Samantha: "The mind boggles. I'll have to check out the exact facts about which contractors are responsible for the reconstruction of Iraq, but I'd compare the current situation with post-war Germany. There we had to temporarily take over some German institutions in a process of denazification, essential in the aftermath of the Holocaust. Only last week a constituent whose grandparents perished in this genocide lamented the lack of awareness in the young population today of these unspeakable crimes against humanity."

Mary Contrary: "Don't you think it's cheap to use the Nazi holocaust to justify crimes committed by your government today? We oppose all tyrannical regimes!"

Samantha: "Oh well, that's what the pacifists said in the run-up to the Second World War. Had we listened to them, we'd enjoy none of the freedoms we take for granted today and you and I might not be talking in this surgery today!".

Mary Contrary: "Look if anyone is appeasing tyranny and genocide, it's not us! It's you guys who support the Bush Junta."

Samantha: "Mary, you seem to be getting paranoid about tyranny in this country. All we want is to work closely with our international partners, NGOs and businesses to bring about a fairer more caring society. We know it's tough and there's a lot of disinformation, conspiracy theories and hate speech on the Internet. Listen there's a group that meets locally for people like yourself who suffer from paranoid delusions. A good friend of mine, Dr Hamish Thotpol, runs the group. Members are encouraged to air their grievances and take part in constructive acts of benevolence, e.g. they organised a bus to the Make Poverty History concert in conjunction with Nokia. They also offer help and support with various therapeutic solutions to make you feel better about yourself!"

Mary Contrary: "Are you suggesting anyone who disagrees with your party line is mentally ill?"

Samantha: "No not at all, just that when we feel depressed about society and paranoid about all these hidden agendas from the likes of John Pilger, we might benefit from talking with professionals who can help us refocus our minds on the things that really matter, like our families, jobs and independent life."

Mary Contrary: "Stalinist b###h!"

Samantha: "I'm terribly sorry I couldn't help you."

Ms Stasy takes a note of Samantha's contact details and calls the local mental health monitoring unit. "Hello, one of my constituents is suffering from an acute form of Paranoid Conspiracy Theory Disorder and I feel she may benefit from a visit from a community psychiatric counsellor. I've recorded our conversation and will forward all correspondence."

"Oh, PCTD. Any hint of antisemitism" asked the friendly helpdesk assistant.

"She did mention Israel in a negative light" the Member of Parliament warned.

"Sounds ominous. And what about oil?" enquired the youthful psychiatric services support consultant, readjusting her headset in a Delhi-based call centre.

"Yes, she seems obsessed with the subject!" remarked Ms Stasy.

The call centre operator confidently uttered her well-rehearsed line "Thank you for passing on this information, Ms Stasy, we'll see what we can do to help."

Categories
All in the Mind

Is AS really on the Autistic Spectrum or are we just redefining Autism?

The overall message we get from the growing AS/Autism support industry is that we are part of the autistic spectrum and we have a psychiatric disorder, even if the language used by professionals when addressing us is much more diplomatic. I agree we have problems with socialisation and manifest behavioural traits that come under the broad umbrella now labelled as Asperger's.

I take issue with this arbitrary extension of the so-called autistic spectrum to include people with a high verbal intelligence quotient and who have very human emotions. It is kind of like saying "You were bullied at school because you're autistic but didn't know it at the time and now you've been diagnosed help is at hand". The truth is most of us were bullied at school because in a highly competitive society obsessed with coolness anyone who fails to conform to such standards is weeded out. As the saying goes "special needs are just weeds". As we are all so different, how could a label help anyone deal with us better. We are just human beings trying to navigate in today's social rat race and often choosing to opt out. I think the problems we experience are shared by a much larger percentage of the population, but to claim that such a reality represents an extension of autism is to misunderstand autism itself or rather to debase its value as a meaningful diagnosis. This term should only be used for individuals with a classic Kanner's autism developmental pattern and with associated cerebral abnormalities. Those who claim that aspies have radically different brains have misinterpreted scant data as most AS-diagnosed people have never had a PET or fMRI scan and recent studies are showing marked difference between the HFA/LFA (traditional autistic) group and the AS group and disproving earlier assumptions about the size of our amygdala (originally attributed to schizophrenics and psychopaths). The latter group manifest varying degrees of synaptic overconnectedness in the orbito-frontal cortex, but this is the most neuroplastic and evolutionarily advanced section of our brain and it is now known that it constantly rewires itself throughout adolescence and way into our twenties and even thirties. So it quite possible that millions could be manifesting AS-like traits not because we were born that way, but because our interaction with the modern environment led us to develop in a certain, with genetic factors only determining relative susceptibility. There seems to be a move to extend the autistic spectrum even further to include ADHD, Tourettes,OCD etc.. In some parts of the UK ADHD diagnosis has reached 1 in 5 children. So if we believe the psychiatric establishment, 1 in 5 kids has a neurological abnormality and will require drugs (they say medication) like ritalin (a commercialised variant of speed) or risperdal (think crack cocaine) for the rest of their lives alongside a support network, with teachers specially trained to deal with challenging behaviour..

This approach, labelling more and more people with one disorder or another, cannot be right. If something is wrong, let's look at the real causes. If we're told our problems are due to a neurological deviation, then we might believe that we need a label and all the stigma that that implies. By contrast if we conclude that society is at fault then we need to change society. Even small changes seem beyond the powers that be. Examples include reducing class sizes (i.e. replacing special needs learning support workers with real teachers and reclassifying all children as having special needs), putting limits on absurd sensory overloads in shopping centres and leisure complexes (loud music) and de-emphasising coolness. Why not? Because such changes would rock too many boats. Teamwork is the order of the day because in reality it means groupthink conformism. Many myths about AS-diagnosed people are spread by ASD evangelisers. We are supposed to lack interest in imaginative play or socialisation. Nothing could be further from the truth. The imaginative play claim comes straight from textbooks that apply to Kanner's syndrome (0.2% of the population according to NAS stats). As for socialisation, just consider why so many AS-diagnosed people get depressed, because we fail to socialise. If we didn't want to socialise, we would not care if others shunned us..

Dyspraxia and hypersensitivity to sounds are very real, but there is simply no magic dividing line between the AS-diagnosed and everyone else, they both represent continua. It may, however, be the case that dyspraxic or hypersensitive children are more likely to be ostracised and develop AS-like behavioural traits. How can one seriously imagine that the enormous lifestyle changes we have witnessed over the last two generations have not led to major psychological changes in a sizable group of adults? Some such as Richard Restak (author of the New Brain) Peter Breggin (author of numerous books on the dangers of ECT, psychiatric drugs and the ADHD fraud) have suggested that ADHD should really be called TV-syndrome. Why? Because it has been proven that excessive exposure to TV (immersion of a virtual reality not just the other side effects of cathod ray tubes) causes the brain to rewire. Remove someone from a high-tech media-obsessed multitasking information-overladen environment and place them in a more traditional slow-paced focused environment and their brains rewires. Of course we are all different, that much should be obvious to anyone who has met more than half a dozen aspies, but we are also first and foremost human beings.

Categories
All in the Mind

AS vs Autism Neuroimaging

Arch Gen Psychiatry. 2004 Mar;61(3):291-8. Investigation of neuroanatomical differences between autism and Asperger syndrome.

Lotspeich LJ, Kwon H, Schumann CM, Fryer SL, Goodlin-Jones BL, Buonocore MH, Lammers CR, Amaral DG, Reiss AL.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94305, USA.

Linda.Lotspeich@stanford.edu

CONCLUSIONS: Lack of replication between previous autism MRI studies could be due to intersite differences in MRI systems and subjects' age and IQ. Cerebral gray tissue findings suggest that ASP is on the mild end of the autism spectrum. However, exploratory assessments of brain-IQ relationships reveal differences between HFA and ASP, indicating that these conditions may be neurodevelopmentally different when patterns of multiple measures are examined. Further investigations of brain-behavior relationships are indicated to confirm these findings.

Functional connectivity in an fMRI working memory task in high-functioning autism.

Neuroimage. 2005 Feb 1;24(3):810-21. Epub 2004 Nov 24.

Koshino H, Carpenter PA, Minshew NJ, Cherkassky VL, Keller TA, Just MA.

Center for Cognitive Brain Imaging, Carnegie Mellon University, Pittsburgh, PA 15213, USA; Department of Psychology, California State University, San Bernardino, CA 92407, USA.

An fMRI study was used to measure the brain activation of a group of adults with high-functioning autism compared to a Full Scale and Verbal IQ and age-matched control group during an n-back working memory task with letters. The behavioral results showed comparable performance, but the fMRI results suggested that the normal controls might use verbal codes to perform the task, while the adults with autism might use visual codes. The control group demonstrated more activation in the left than the right parietal regions, whereas the autism group showed more right lateralized activation in the prefrontal and parietal regions. The autism group also had more activation than the control group in the posterior regions including inferior temporal and occipital regions. The analysis of functional connectivity yielded similar patterns for the two groups with different hemispheric correlations. The temporal profile of the activity in the prefrontal regions was more correlated with the left parietal regions for the control group, whereas it was more correlated with the right parietal regions for the autism group.

Semin Pediatr Neurol. 2004 Sep;11(3):205-13.

Imaging data in autism: from structure to malfunction.

Acosta MT, Pearl PL.

Department of Neurology, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, DC 20010-2970, USA. macosta@cnmc.org

During the last two decades, neuroimaging studies have improved our knowledge of brain development and contributed to our understanding of disorders involving the developing brain. Differences in cerebral anatomy have been determined in autism spectrum disorder (ASD). Morphological studies by magnetic resonance imaging have provided evidence of structural differences in ASD compared with the normal population. This has enhanced our view of autism as a neurobiological disorder corresponding with different stages and events in brain development. Alterations in volume of the total brain and specifically the cerebellum, frontal lobe, and limbic system have been identified. There appears to be a pattern of increased and then decreased rate of brain growth over time. We integrate these observations with neurobehavioral findings to provide a developmental hypothesis of the pathophysiology of autism.

Dev Med Child Neurol. 2004 Nov;46(11):760-4.

Voxel-based morphometry elucidates structural neuroanatomy of high-functioning autism and Asperger syndrome.

Kwon H, Ow AW, Pedatella KE, Lotspeich LJ, Reiss AL.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA. howerk@alum.mit.edu

Efforts to examine the structural neuroanatomy of autism by using traditional methods of imaging analysis have led to variable findings, often based on methodological differences in image acquisition and analysis. A voxel-based computational method of whole-brain anatomy allows examination of small patterns of tissue differences between groups. High-resolution structural magnetic resonance images were acquired for nine males with high-functioning autism (HFA; mean age 14y [SD3y 4mo]), 11 with Asperger syndrome (ASP; mean age 13y 6mo [SD2y 5mo]), and 13 comparison (COM) participants (mean age 13y 7mo [SD 3y 1mo]). Using statistical parametric mapping, we examined contrasts of gray matter differences between the groups. Males with HFA and ASP had a pattern of decreased gray matter density in the ventromedial regions of the temporal cortex in comparison with males from an age-matched comparison group. Examining contrasts revealed that the COM group had increased gray matter density compared with the ASP or combined HFA and ASP group in the right inferior temporal gyrus, entorhinal cortex, and rostral fusiform gyrus. The ASP group had less gray matter density in the body of the cingulate gyrus in comparison with either the COM or HFA group. The findings of decreased gray matter density in ventromedial aspects of the temporal cortex in individuals with HFA and ASP lends support to theories suggesting an involvement of these areas in the pathophysiology of autism, particularly in the integration of visual stimuli and affective information.

PMID: 15540637 [PubMed - indexed for MEDLINE]

Hippocampus and amygdala volumes in parents of children with autistic disorder.

Am J Psychiatry. 2004 Nov;161(11):2038-44.

Rojas DC, Smith JA, Benkers TL, Camou SL, Reite ML, Rogers SJ.

Department of Psychiatry, University of Colorado
Health Sciences Center, Box C268-68 CPH, 4200 E. 9th Ave., Denver, CO
80262, USA.

Don.Rojas@uchsc.edu

OBJECTIVE: Structural and
functional abnormalities in the medial temporal lobe, particularly
the hippocampus and amygdala, have been described in people with
autism. The authors hypothesized that parents of children with a
diagnosis of autistic disorder would show similar changes in these
structures. METHOD: Magnetic resonance imaging scans

were performed in 17 biological parents of children with a diagnosis of DSM-IV autistic disorder. The scans were compared with scans from 15 adults with autistic disorder and 17 age-matched comparison subjects with no personal or familial history of autism.

The volumes of the hippocampus, amygdala, and total
brain were measured in all participants. RESULTS: The volume of the
left hippocampus was larger in both the parents of children with
autistic disorder and the adults with autistic disorder, relative to
the comparison subjects. The hippocampus was significantly larger in
the adults with autistic disorder than in the parents of children
with autistic disorder. The left amygdala was smaller in the adults
with autistic disorder, relative to the other two groups. No
differences in total brain volume were observed between the three
groups. CONCLUSIONS:

The finding of larger hippocampal volume in autism is suggestive of abnormal early neurodevelopmental processes but is partly consistent with only one prior study and contradicts the findings of several others. The finding of larger hippocampal volume for the parental group suggests a potential genetic basis

for hippocampal abnormalities in
autism.

PMID: 15514404 [PubMed - indexed for MEDLINE]

Cerebellar function in autism: functional magnetic resonance image activation during a simple motor task.
Biol Psychiatry. 2004 Aug 15;56(4):269-78.
Allen G, Muller RA, Courchesne E.

Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

BACKGROUND: The cerebellum is one of the most consistent sites of neuroanatomic abnormality in autism, yet it is still unclear how such pathology impacts cerebellar function. In normal subjects, we previously demonstrated with functional magnetic resonance imaging (fMRI) a dissociation between cerebellar regions involved in attention and those involved in a simple motor task, with motor activation localized to the anterior cerebellum ipsilateral to the moving hand. The purpose of the present investigation was to examine activation in the cerebella of autistic patients and normal control subjects performing this motor task. METHODS: We studied eight autistic patients and eight matched normal subjects, using fMRI. An anatomic region-of-interest approach was used, allowing a detailed examination of cerebellar function. RESULTS: Autistic individuals showed significantly increased motor activation in the ipsilateral anterior cerebellar hemisphere relative to normal subjects, in addition to atypical activation in contralateral and posterior cerebellar regions. Moreover, increased activation was correlated with the degree of cerebellar structural abnormality. CONCLUSIONS: These findings strongly suggest dysfunction of the autistic cerebellum that is a reflection of cerebellar anatomic abnormality. This neurofunctional deficit might be a key contributor to the development of certain diagnostic features of autism (e.g., impaired communication and social interaction, restricted interests, and stereotyped behaviors).

Less white matter concentration in autism: 2D voxel-based morphometry.

Neuroimage. 2004 Sep;23(1):242-51.
Chung MK, Dalton KM, Alexander AL, Davidson RJ.
Department of Statistics, University of Wisconsin-Madison, Madison, WI 53706, USA.
mchung@stat.wisc.ed

Autism is a neurodevelopmental disorder affecting behavioral and social cognition, but there is little understanding about the link between the functional deficit and its underlying neuroanatomy. We applied a 2D version of voxel-based morphometry (VBM) in differentiating the white matter concentration of the corpus callosum for the group of 16 high functioning autistic and 12 normal subjects. Using the white matter density as an index for neural connectivity, autism is shown to exhibit less white matter concentration in the region of the genu, rostrum, and splenium removing the effect of age based on the general linear model (GLM) framework. Further, it is shown that the less white matter concentration in the corpus callosum in autism is due to hypoplasia rather than atrophy.

Categories
All in the Mind

Obsessive Delusional Heterodoxy Disorder (ODHD)

Most people have an aptitude for teamwork and instinctively know when constructive discussion and even new ideas are both welcome and socially advantageous. But some are not so fortunate. They live in a state of paranoid fear and dismiss conventional wisdom on most issues, often leading to obsessional interest in erudite subjects, sympathising with tyrants, downplaying atrocities and inventing absurd conspiracy theories. In synthesis they turn reality on its head, never believing anything emanating from respected mainstream sources.

Some delusional obsessions may be quite innocent, e.g. a woman from Philadelphia, Pennsylvania, is convinced that all modern ailments are caused by a ubiquitous sugar substitute. On her weekly grocery shop she methodically reads the labels of every single product she buys and occasionally complains if a new sweetener has been added to a product she likes. Her delusion may cause her some anxiety, she may be denied the benefits of sugarfree sweeteners, but by and large her life is still viable.

Since September 2001 until a recent course of psychiatric treatment, Boston software developer, Ed Munchen, had been convinced Aliens from the planet Domu remote-controlled airliners into the World Trade Center to fool the United States into an unwinnable war against terrorism and prime the planet for an Alien takeover. He dedicated his life's savings and 100% of his time to his impressive web site complete with edited footage of the attacks and interviews with green twelve-fingered extraterrestrials.

However, some delusions are not that innocent. Ed's second cousin, Nick Simpson, now living in Portland Oregon, still believes the Holocaust was invented by Jews as a propaganda tool in their quest for global dominance. His views cause considerable offence to millions whose relatives perished in the Shoah. Like his East Coast counterpart he dedicates much of his time to Internet activism, often lampooning and insulting those who believe in the best-documented genocide of the last century.

In many European countries, Nick's views and actions might put him behind bars. Over here he is protected by the first amendment, but that doesn't make him any less a threat to our fragile democracy. University of Wisconsin Neuroscientist, Hillary Redburn, has analysed over 200 patients with a variety of obsessional delusions. "Until recently", she said, "we might have branded these people political hotheads, extremists or fanatics, but now we know they have a genetic predisposition to heterodoxy, a pathological tendency to challenge orthodox views and systematically re-analyse evidence to prove the opposite. They probably account for around 1% of the population, though their distribution may occur in clusters. Symptoms tend to appear at an early age. At first, their delusions may seem quite innocent or even healthy. Nick, the Portland-based Holocaust denier, spoilt the family Christmas at the age of 4 because he kept telling his grandfather that Santa Claus was just a myth perpetrated by grown-ups to keep children quiet. He may have been right in that case but his proclivity to challenge everything led him into deeper trouble at school. He would interrupt physics lessons to explain why he thought the big bang was just a wild creationist theory and claim in English lit lessons that Shakespeare did not pen his own works, but would always play devil's advocate in the school debating society."

Psychologists have long wondered why some of us are more conformist and others more rebellious, some more credulous and others less so, but should it be a problem I asked Prof. Redburn. "Yes, because most sufferers of Obsessive Delusional Heterodoxy Disorder or ODHD, lead very unhappy lives, are very prone to depression and may unleash their wacky ideas on others without any consideration for the offence they cause, e.g. a client from Illinois is convinced Walmart plan to put every American out of a job. When her 17 year old daughter returned from a shopping spree with two Walmart bags full of summer clothes she'd need for her vacation the next day, she emptied the contents into the garbage can. As a result, her daughter did not go on vacation and only recovered after professional counselling and a course of SSRIs.

ODHD sufferers believe they are on a mission to save humanity or reveal hidden truths. They like to quote George Orwell or cite the case of Galileo Galilei, but they have no idea how much offence they cause others or the consequences of the extremist views they hold."

So what should we do, I inquired. "These people need our help and support. Data from fMRI scans indicate a chemical imbalance in their frontal cortex, which overstimulates neuroreceptors responsible for critical thinking. In normal human beings, such receptors are counterbalanced by others responsible for harmony and acquiescence. We believe it is important to diagnose these individuals as early as possible. The government's mental health screening initiative offers us an excellent opportunity to help ODHD sufferers before it's too late and they turn into little Hitlers, Stalins or Saddam Husseins. Though the Illinois housewife who religiously boycotts Walmart may be on the mild end of the ODHD spectrum, her neurological profile shows surprising similarities with that of the guy who thinks Auschwitz was just a leisure complex. But with the right medication, behavioural support and tolerance training these people can become model citizens."

"Don't psychiatric drugs have side effects"?" I quipped.

"Some do, but our understanding of brain chemistry means we can now target specific psychological disorders with minimal side effects. In most cases I would recommend Submissal TM. It induces a feeling of elation, acquiescence and tolerance in most users, though it may temporarily disrupt sleeping patterns and is not recommended during the last two months of pregnancy."

"And what about the support network?"

"That's absolutely essential. We're currently training counsellors and learning support workers to deal with ODHD sufferers, just help them overcome their delusions, ensure they take their medication and basically keep out of harm's way"

"Any success stories you'd like to mention?"

"Sure, Ed Munchen, revised his theory and concluded that Iraqi Resistance Fighters utilised a time machine to engineer the 9/11 attacks. He has since joined the US Army and participated in the liberation of Falluja. His web site is now dedicated to Iraqi democracy. I can honestly say he has been freed of all obsessive delusions. He even said he'd like to join in the coming liberation of Iran."

Categories
All in the Mind

Empiricism and Idealism

Our species has evolved a curious form of opportunistic altruism, in short the notion that we benefit by caring for one another, while each individual strives insofar as possible to enhance his or her own social status, personal security, wealth and power. Thus much political debate concerns the dichotomy between the common good and individual freedom. Idealism merely represents a set of beliefs in an optimal world, where individuals attain the greatest measure of happiness, satisfaction, affection, personal freedom, physical and material wellbeing. Propagandists like to pepper their speech with frequent references both to our aspirations and to the political ideals dear to our culture or doctrinal system. In much of the world today we have been conditioned to view abstract concepts such as democracy, freedom, antiracism, tolerance, crime-prevention, material wealth as ideals worth fighting for, often with scant regard to their feasibility and the immense contradictions and conflicts of interest that their rigorous enforcement may engender.

An idealist may simultaneously advocate greater economic growth, campaign for a cleaner environment and welcome migration from poorer to wealthier regions, as we all want to enjoy a higher material standard of living, surrounded by uncontaminated, but tamed wildlife and extending such privileges to an ever greater number of world citizens. An idealist can espouse tolerance for diverse lifestyles and intolerance for all kinds of prejudice, without considering whether one's lifestyle conflicts with rights and freedom of others.

Empiricism relies on the morally neutral application of the scientific method. Only ethics tell us that actions such as planting an incendiary device outside a busy restaurant or firing missiles at densely populated neighbourhoods from helicopter gunships are wrong. An empiricist is interested only in establishing the facts and in understanding the motivations of the perpetrators. An empiricist may want to estimate the Earth's long-term human carrying capacity, within verifiable physical technological restraints, regardless of the millions who may die if it proves significantly lower than world's current population. An empiricist may seek to establish whether cold fusion is both technically viable and safe irrespective of any ideological preconceptions or rigid interpretation of the theory of thermodynamics. More important an empiricist can change her or his view on the basis of new scientific data. For instance, if one could prove global oil reserves could last another 300 years without any adverse climate and/or ecological effects, one may need to revise one's view on sustainability of our current petroleum-driven economic model and seek alternative explanations for conflicts over oil supplies.

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All in the Mind Power Dynamics

By persuasion if we can, but by coercion if we must!

The liberal media's reaction to reports of widespread abuse and torture of Iraqi detainees by US and UK military personnal marks a psychological turning point in the current phase in the sole superpower's war for total global domination.

Recent interventions have been justified in one way or another by our moral superiority, our more advanced, more humane form of civilisation, our crusade to spread democracy and liberal values. Whatever the crimes committed by high-tech weapons systems, whatever the abuses carried out at Guantanamo Bay, whatever the evidence of CIA-funding for the KLA or Al Qaeda, whatever the flaws in the allegations made against the former Yugoslav government, Britain - we were told - represented a beacon of justice and fairness.

No sooner had our brave service men and women liberated a new territory, the liberal media progressed to stage two, reconstruction via international bank loans and rehabilitation via NGOs. British experts would be sent all over the globe to teach our enlightened ways to people accustomed for so long to only dictatorships (with whom we used to do business). Thus for paid intellectuals like Johann Hari of the Independent or David Aaronovitch and Nick Cohen of the Guardian, new military adventures provided a new opportunity to spread our values.

Wouldn't it just be wonderful if the whole world became a multi-hued mosaic of dominant post-1980s Anglo-American culture? Sure McDonalds would localise its burgers for the Mid East market, MTV would broadcast some Arabic rap, juicier scenes from Hollywood movies would be edited out and people would speak English with different accents and continue to learn local dialects for a couple more generations. But rest assured your Lonely Planet Guide to Iraq will feature an extensive list of gay nightclubs in downtown Baghdad. Okay Iraqis may have more traditional values now, but given time greater exposure to our benign media will usher in a new era of carefree hedonism.

US and UK crimes could easily be brushed aside by stressing the repressive nature of all local or nationalist alternatives. So pundits would opine that we need to stay the course in Iraq to stop Islamic extremists or Saddam Loyalists from (re)gaining power. Democracy has only one meaning: A pacified electorate happy to vote for responsible politicians who collaborate fully with the international community as defined by the Coalition.

To understand the chasm emerging within our ruling elite witness yesterday's Scottish Daily Record and UK Daily Express - not a word about US and UK crimes, just a page two article about Moqtaba Al-Sadr's threat to use captured female British soldiers as slaves. Then read the liberal press. The underlying message is Abu Ghraib represents a setback for the spread of our civilisation, very bad PR. Now the damage has been done, a section of the ruling elite, the same opinion-makers who campaigned passionately for humanitarian wars, want our troops out. But the die has already been cast. Withdrawal will leave the US in a significantly weaker position in the Middle East than it enjoyed in February 2003. Whether or not, US and UK armed forces retreat strategically, their dependence on near absolute control of the world's oil reserves is so great that they will just seek new and devious means.

It's time the left gatekeepers, as some call the likes of Greg Palast (who thinks the Beeb allows objective reporting), started challenging assumptions about our moral superiority and start publicly admitting rather than merely implying the real motivations for war. Torture and violence are not unAmerican any more than they are unChinese or unArabic. They are classic tools of conquest. As Madeleine Albright said "We will act multilaterally when we can, unilaterally when we must."

Let's paraphrase that: We will act by gentle persuasion where we can and by physical coercion and advanced brainwashing techniques where we must. What the liberal media is telling us is that the era of gentle persuasion is nearing its end.