Possibly Unwanted Implications of the Pathologization of Sex Crimes

The current DSM-V draft, as many people have already noted, greatly expands the scope of paraphilias. For example, paraphilic coercion disorder is added and pedophilia is expanded to include pubescent teens. Most people whose commentary I have read, are not pleased with these changes, because, as they say, they will lead to an increasing number of sex offenders claiming an insanity defense.

This fear is, at least in the Dutch legal system, quite legitimate. Unlike in the United Kingdom and the United States, we do not have a specific definition of insanity, like the McNaughton test. Anyone whose mental illness significantly impacted their crime, can be declared partially or completely insane. Partial insanity seems like something pretty specific to the Dutch situation. In this case, you will still be held partially accountable for your crime, and will get a reduced prison sentence along with forced mental treatment. Complete insanity defenses, in which case a criminal will be sent directly to a mental hospital without prison time, are reserved for extremely rare cases. This is not a decision made by forensic psychiatrists, since “insanity” is not a psychiatric term; it was the High Court that decided complete insantiy should be exceptional.

In the Dutch system, the fields of forensic psychiatry and criminal justice are more interconnected than they should be. For example, a forensic psychiatric diagnosis is always made in the context of the crime the person is being accused of. This would seem logical, but it leads to some interesting circular arguments. For example, assume that someone is charged with child sexual abuse. This person is sent to the Pieter Baan Center (our national forensic assessment center) for psychiatric evaluation. There, the crime is taken as the starting point for the psychiatric assessment, so it is hypothetized that the person actually did abuse one or more children. The Pieter Baan Center is not known for its state-of-the-science evaluations, so it is quite possible that any behavior could be interpreted as an indication for pedophilic fantasies. Thus, the person is diagnosed with pedophilia rather easily, regardless of whether they actually admit to pedophilic thoughts. However, even if the person confesses to sexual fantasies involving children, this by itself should not lead to a diagnosis of pedophilia unless the person has acted upon these fantasies (or unless the fantasies caused significant impairment or distress), which can be deduced from the person’s child abuse charge. So, a person is diagnosed with a mental illness on the grounds that they perpetrated a crime. By definition, that mental illness impacts the person’s crime, so almost by definition, they will be declared (partially) insane.

However, let’s be clear here that, when a suspect is being assessed at the Pieter Baan Center, they haven’t yet been convicted. Because the Pieter Baan Center psychiatrists take the charges as the starting point for their diagnosis, they could theoretically be fabricating evidence through their psychiatric report. According to a recent work by W.A. Wagenaar and others, this is in fact not merely theoretical: they report extensively on a case in which a person, claiming to be innocent, was convicted of horrific child sexual abuse for the most part because a psychiatrist had diagnosed him with pedophilia, on the grounds of the (very dubious) evidence for his sex crimes. The person was convicted of the crime, declared insane, sent to a mental hospital, and will possibly stay there for life, because the first step in treatment is confession to the crime. This is of course a circular argument: you are insane because you allegedly committed a crime, and you have committed the crime because the psychiatrist declared you insane for it. Will this risk be extended if more sex crimes are being pathologized?

But even in the vast majority of cases, where the suspect actually committed the crime, is it desirable that this crime be increasingly pathologized? Even though insanity is, at least in the Dutch legal system, by no means an easy way out, the general public does have an opinion that sex offenders should be punished and not treated like victims of a mental illness. Of course, in terms of risk to the public, it may be easier to pathologize and institutionalize all sex offenders, because in that case one can be sure that they won’t be released into the community until they have been treated. This could mean that sex offenders who deny their crime will be locked up for life rather than released after a certain sentence. Also, forensic psychiatric hospitals are not the sort of hotels people think of: in some respects, you have it worse there than in prison. However, that does not do away with the connotation of sex offenders as victims of mental illness rather than personally responsible for their crimes, and this is actually a legitimate complaint against the pathologization of criminal behavior: we assume that criminals are responsible for their behavior unless a mental illness diminishes this responsibility. Why should something inherent in the crime, rather than something inherent in the perpetrator, annihilate this personal responsibility?

Reference

Wagenaar WA, Israels H, and Van Koppen PJ (2009), De slapende rechter: waarom het veroordelen van burgers niet alleen aan de rechter kan worden overgelaten, Chapter 8: De zaak-Tamboer. Amsterdam, Netherlands: Bakker.

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What Shall We Do With Irritable Adults?

When searching PubMedCentral for articles relevant to the proposed diagnosis of temper dysregulation disorder with dysphoria, I came across an interesting paper discussing controveries in the current DSM diagnosis of irritability. Temper dysregulation disorder with dysphoria, or its alternative name, severe mood dysregulation, was not mentioned, but a number of interesting issues were discussed, especially for the diagnosis of adults.

As the author states, there is no current DSM diagnosis for adults who show frequent anger or irritability but no aggressive behaviors. The two possibly relevant diagnoses, antisocial personality disorder and intermittent explosive disorder, after all, both require that the person has displayed acts of destruction or assault. I begin to believe that my (former, I might hope) diagnosis of impulse control disorder NOS, back in 2008, was an awkward attempt at categorizing my irritability somewhere. Of course, in my case, it wasn’t all that necessary, if my doctor had looked beyond the surface of the DSM-IV criteria for autism, but that’s not the point. The author, namely, contends it as a problem that irritability is spread out over so many non-specific diagnoses in adults, when in fact it is not a core feature of any of these diagnoses. For example, it is said to be a possible defining characteristic of a manic episode, when in reality most people in a manic phase are not primarily irritable. It is also a descriptor of generalized anxiety disorder, posttraumatic stress disorder, and pathological gambling, among others, all of which would not be diagnosable if the person were merely irritable. Lastly, it is a non-core feature of a huge number of disorders, such as ADHD, intellectual disability and dementia. It is not in the DSM criteria of any of these conditions, but it is very commonly seen in patients diagnosed with them.

There are several solutions proposed for this nonspecificity of irritability. One of them is to expand the category of mood disorders to include dysfunctional anger and anxiety. The author prefers dysfunctional anger over irritability, but I did not really understand why. The inclusion of a separate mood category for anger, however, could, in my opinion, be somewhat confusing, given that the author also proposes a number of changes that reflect the idea that adults can have behavioral disorders with irritability, too. How is one going to distinguish irritable moods from irritable behavior disorders?

The author proposes to expand the diagnosis of oppositional definant disorder to adults, and to move the diagnosis of intermittent explosive disorder into a new category of social behavior disorders. The reasoning behind the latter is rather weird: IED is currently listed as an impulse control disorder, but, since none of the other specific impulse control disorders are truly impulsive, IED has to move. Why does this fact suddenly make IED not an impulse control disorder but a behavior disorder?

The other proposal, to expand the diagnosis of ODD to adults, makes little sense to me, too. The reason is not that adults cannot possibly display inappropriate anger, or kind of egocentric reasoning like the fact that I don’t want to be labeled with a “behavior disorder”, but the context in which ODD is set. That is, ODD is clearly presumed to be a disorder of obedience to authority, while in reality the vast majority of people of all ages who are irritable, do not have the purpose of defying authority. This is one of my major problems with the diagnosis of ODD in general: if a child is often irritable, it is readily assumed that they are so on purpose, and that the specific purpose is to defy the power dynamics in which they live. It is already probleematic for children, but it is even more problematic for adults, because, in most real-life contexts, they are not supposed to be obeying someone else at all times. Of course, there are power structures in adult life, too – at college or work, with the police, etc. -, but they are not as clearly present as the conventional parent-child power dynamic. On the other hand, however, as soon as a person of any age enters the healthcare system, especially psychiatry, they enter a power dynamic. If ODD is expanded to include adults, will it not be abused to merely describe the “non-compliant” patient?

I do think a diagnostic category is warranted to describe severe irritability in people of all ages, but I already have a problem with the artificial distinction between irritable moods and irritable behaviors. If a patient is neither depressed nor manic, how can a clinician tell whether they are having an irritable mood or displaying “oppositional” behavior? In children, ODD and mood disorders often coincide – and they did before the large-scalde overdiagnosis of “pediatric bipolar”, I might say. This does not mean that all these children have classic depression: in fact, many display the irritable variant of current major depressive or dysthymic disorders. If irritability is included as a descripptor of mood disorders in people of all ages, or even as a separate mood disorder category, the water gets even muddier: will pretty much every adult with irritability then receive a comorbid diagnosis of ODD and a mood disorder with irritability? For children, the proposed TDD diagnosis might solve this – if it is not used as an excuse to label even more children not in need of labels at all -, but this disorder doesn’t apply to adults. So, what will we do with the irritable adult?: diagnose them with a “behavior disorder” regardless of their mood, diagnose even more people with mood disorders, diagnose them with both a “behavior disorder” and a mood disorder, eventually expand TDD to include adults – with all possible consequences not yet foreseeable -, or what? So far, it doesn’t seem like DSM-V is going to come up with a useful solution.

Reference

Safer DJ (2009), Irritable mood and the Diagnostic and Statistical Manual of Mental Disorders. Child and Adolescent Psychiatry and Mental Health, 3:35. Published online: October 24, 2009. doi: 10.1186/1753-2000-3-35. PMCID: PMC2773760

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My Blog Doesn’t Tell You Exactly How Autistic I Am, and It’s Not Your Business Anyway

In discussions involving neurodiversity issues, when all real arguments have been exhausted, I am usually met with questions casting doubt on my identity as an autistic. Did I ever spend a day in special education or an institution? Can I speak, dress myself, use the toilet? How many times did I scream, bang my head, hit my caregiver within a set timeframe? I usually don’t answer these questions, since they are usually entirely irrelevant. However, beyond this, many are none of your business.

I am relatively open about my personal life on this blog, when compared to other neurodiversity bloggers. For this reason, whether I was ever in specail education or an institution, is too dumb a question to ask. However, the fact that I am open about being institutionalized at this moment and having spent years in special ed, does not mean that I will also be open about my every autistic difficulty. Even if I could’ve done so, I would not have liveblogged a meltdown: you have no reason to know about my problem behavior. Some examples of meltdowns can be found in the archives of thsi blog, if you really badly want to know. Other more open accounts of problems I used to have, can also be found in the archives, but I am not as eager to write about them now. Just because I don’t blog about them now, however, doesn’t mean they don’t exist.

Besides my choice not to disclose every single problem I’m facing, there is also the fact that I cannot explain a number of problems I am experiencing. I have been wanting to do an “Autism 411″ series on some of these problems, not for the purpose of letting curebies know how oh so pitiful I am, but merely for informational purposes. However, I’ve not gotten down to it because I simply cannot write about some of the issues I want to write about. I do not fully understand the issues myself, cannot find the words to describe them, or I cannot combine them into a sensible blog post. This does not mean these difficulties are not real.

There are also a number of problems that I indirectly write about. For example, I have criticized the Dutch long-term care system many times, and posted some specific examples of Dutch people in need of help because they were stuck in the system. The fact that I do not write as much about my own situation lately, does not mean that I face no problems with the care system. In fact, I do, but I cannot articulate these problems all the time.

But the biggest reason for my unwillingness to share every detail about my autistic difficulties is actually the very attitude of identity erasure. Curebies will always find a reason to disbelieve me anyway. Even if I published my care records online, people would still find a reason to doubt they are real or say anything. And even if you somehow weren’t going to look for every tiny bit of evidence that I am not “really” autistic, that should not be the point. People should not have to prove their autism over the Internet to someone they don’t know in order to have the right to express themselves as autistics. Your opinion on how “really” autistic I am, does not change the reality of my autism, after all.

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Having a Miscarriage Now a Crime in Utah

According to a post on RHRealityCheck.org, a pro-choice commentary site, Utah passed a bill to criminalize miscarriage. To be exact, a woman can be charged with homicide for any “reckless” behavior that possibly led to a miscarriage. This is not limited to seeking an illegal abortion or even to risky behavior with the intention of inducing a miscarriage, such as when a teenage girl paid someone to assault her in order to induce a miscarriage. Really, there is no mention that the intent of the woman’s behavior should be to terminate the pregnancy. Even if a woman engages in behavior that could endanger the unborn child, but she has absolutely no intention of actually killing the baby, she can still be held legally responsible if she has a miscarriage. Since I did not read the original text of the bill, I do not know how it defiens “reckless” behavior. What about a woman who drinks or smokes during pregnancy, both of which increase the risk of miscarriage? What about a woman who is unable or unwilling to follow doctor’s orders to take bedrest, such as the woman in Florida a few months ago who was detained in hospital for this very reason? What, in fact, about women who have miscarriages for an unknown reason? Will they be subject to criminal investigations while mourning the loss of their unborn child? It really seems that this bill is grounded in the belief that all women go around trying to end pregnancies all the time, rather than the fact that most women who miscarriage, even if they engaged in some “reckless” behavior – as most pregnant women will have done at some point -, had absolutely no intention of killing their unborn babies.

Besides, doesn’t the Utah police have anything better to do than investigating miscarriages? Miscarriages are pretty common, unfortunately. So is behavior among pregnant women that could put the unborn baby at risk. Whether the two are connected, is not always easy to tell, which means a pretty thorough investigation is needed in order to gain substantial evidence that the woman’s miscarriage was illegal. I do not think the tiny chance of saving an unborn baby’s life weighs up to the huge risk to many women’s human and civil rights and their wellbeing. Indeed, this bill does not look like a sensible pro-life measure at all. Rather, it is a draconian effort to police the way pregnant women take care of themselves and their unborn babies and, beyond that, a state-sponsored blame game of every woman (whether she is eventually charged or not) who has a miscarriage.

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Labor Pulls the Plug on the Dutch Government After All

Last month it seemed like the Dutch Labor Party would readily trade its principles for an extra year on a government in which it has nothing to say anyway. The Iraq war report, which shot prime minister Balkenende’s actions to pieces, could’ve been somewhat of an acceptable reason for a government collapse. However, Labor Lower House leader Mariëtte Hamer wouldn’t even take the great opportunity last Monday to support a motion calling for the government resignation. If she’d done so, she could’ve blamed Balkenende at least for some part of the government collapse, in the sense that, well, he flip-flopped on what the report said. It would still be rather nonsensical if Hamer had pulled the plug only last Monday, when she had every chance to do so last month, but oh well.

It is not about Iraq, however. It’s about Afghanistan. Labor leader Wouter Bos – turns out he is the real leader after all – keeps saying that the government promised the voters that we’d leave Uruzgan by 2010. Apparently this time, just ten days before the local elections, it is somehow important to stick to one’s “promises”, because maybe now we can gain some electoral favors that way. They of course weren’t the Afghan voters who were promised anything about protection from militant Taliban. I, for one, happen to have been against the war back in 2001, but now that we bombed Afghanistan anyway, it is our duty to protect the people living there. It isn’t like we can bomb away a foreign government we do not like and then leave it up to the people to rebuild their country from zero.

According to Bos, the government collapse had become inevitable yesterday night after Balkenende had told him to shut up about his idea that a prolonged stay in Uruzgan would be politically unfeasible and to just accept the standpoint that all options are open. Bos is right that this didn’t use to be the official government position – back in 2007 when it was decided that we would stay in Uruzgan till 2010, the government promised the Dutch people that we would really be leaving by then -, but what is the point? If Bos’ real point is that his opinion was being silenced because the other parties on the government had changed their minds, why didn’t he pull the plug on the government back over the Iraq report? At the time, Labor was silenced, too, since Balkenende gave a wee apology about his statement that the report was just an “opinion”, and from then on, everyone was supposed to say that the government had always agreed on Iraq. Since they obviously didn’t, and since now it seems Bos’ freedom of expression is more important than the will to keep on governing, why wasn’t it last month? Seems to me like Bos is playing the election card again. Either that, or he is burned out and knows no other way to let it know than to kill the entire government. My sister says an election date for the Lower House has been set for May 12, but on the news last night I heard nothing more clear than “late May or early June”.

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Going on an Antipsychotic for Irritability Again

This is just a note to say that I will be going back on an antipsychotic for my irritability and oversensitivity. This time, it will be aripiprazole (Abilify) 7.5mg. The psychiaatrist says I should be seeing results within four weeks, so I will be taking the drug for a while and hope that it works. Of course I may have disagreements with the staff about effectiveness, but we did get it clear that, while trying to reason is fine, I am ultimately the one who decides whether I take this drug or not. (Of course since I am a voluntary patient, that is my legal right already, but it is good to communicate these matters anyway.) I do trust my current staff more than I did the people involved in 2007 to make a reasoned assessment of whether they think the drug is effective, in the sense that they know me before I go on meds, so they aren’t motivated by fear of what might happen if I quit a med they’ve never seen me without. Conversely, not having a move on the way anytime soon gives me some more capacity to evaluate effectiveness, too, since it isn’t like, if the Abilify doesn’t work, it is just as possible that my stress level increased a million times over the course of a week and, if it does work, it is not like I just got it a lot easier through a huge change in external circumstances (not that I see what huge change in external circumstances could make it magically easier for me, but well). I do of course hope that I made it clear enough that my going on medication is no excuse to make life a hell of a lot tougher for me, anyway.

I am not reading any more leaflets of millions of side effects, because all the sources I’ve checked out disagree on relative risks, and I am already well aware of all the different side effects that can come with antipsychotics, and relative risk doesn’t say all that much with me anyway. The psychiatrist did say that it is possible I will be having some movement effects, which I have never had before on any of the other neuroleptics I took (but then again, one was obviously atypical and the other a low-potency classic), so I will have to see if they pop up and, if so, whether they are really as horrible as I’ve read some can be.

We did have some discussion on the time of the day I would have to take my medication. At first, the psychiatrist thought it best if I took it before bedtime, because of something about it not interfering during the day (so am I not supposed to benefit from it during the day?). That didn’t sit all that well with me given the risk of physical and mental restlessness (and the fact that I’d much rather experience any side effect during the day anyway), but I didn’t point that out. Eventually, I got my way through some really hard-to-follow discourse of thought from the psychiatrist, and I can now take it in the morning. That will come down to around 10:30 AM since I already take medication then. He pointed out that it didn’t really matter if I was not always on time with my meds, but I do have to ask the staff to remind me, since I’m not all that good with remembering to take my meds. Do wonder how I managed that back in 2007, when I to my knowledge never missed a single dose of Risperdal, except when I was deliberately non-compliant, of course, which I have no intention of being again.

Ultimately, if the drug is not effective or is causing me intolerable side effects, I will feed it to the gull with carob-induced autism to see if it decreases his irritability. If natural health products can solve the problems created by Big, Evil Pharma, I would hypothetize it goes the other way around, too. Oh, before the Animal Liberation Front comes out to get me, that was a joke.

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Sexual Abuse in Institutional Settings: Legal Psychology and the Belief Controversy

Anna had a post up at FWD/Forward about the fact that many disabled students are not believed about sexual abuse at institutions. First of all, let me say that it is probably true that institutions like to cover their own arses, and, for this reason, would rather not have sexual abuse, especially large-scale sexual abuse or sexual abuse perpetrated by figures of authority, came to the public. It is possibly for this reason that institutions often start investigations of their own before involving the police. But this is exactly a risk factor for false accusations.

Now let me say that some of the same reasons why people in institutions run a potentially increased risk of constructing false accusations of sexual abuse, are also risk factors for disbelief of sexual abuse that actually did happen. For example, if a person with developmental disabilities has trouble communicating about an incident, and this leads the police or an institution investigator to believe they were sexually abused when they weren’t, the same communication difficulties can lead to the person not being able to communicate abuse that did actually happen effectively. The legal pscyhology books, particularly by W.A. Wagenaar, I read, often emphasize the risk of false accusations, because, as Wagenaar thinks, there is a rather hysterical culture around taking every single case of even remotely suspected sexual abuse seriously, especially in institutional settings. I am not sure whether this is actually true, since some other information I have found, actually claims, like Anna, that sexual abuse in institutions is disbelieved and underreported. My inclination is that both are true to some extent: there is a risk of sexual abuse victims being disbelieved, and there is a risk of false accusations.

Note that the vast majority of false accusations are not deliberately false. There are a number of factors that can contribute to a false allegation of sexual abuse that are beyond the presumed victim’s control. One huge such factor is the risk that a story of sexual abuse is constructed through suggestive investigation by untrained people before the police are involved. For example, if someone communicates something that may have indicated sexual abuse, it is possible that the people around that person (parents, institution staff, etc.) are trying to find out what happened, and, them being untrained, this poses the risk of these people suggesting things rather than letting the person recall their own experience. Wagenaar has a number of instances of so-called “collaborative storytelling”, some of which involving institutional settings and one of which involving a person with disabilities, described in his books. Most of these cases involved suspects being convicted while (likely) innocent.

Now you may say that sexual abuse is such a serious crime, and is often so hard to prove given that usually the perpetrator makes sure no traces are left, that maybe a little sloppy investigation is warranted for the sake of the victim(s). I disagree: no matter how serious a crime is, the suspect has rights, too. They run the risk of long prison sentences, up to practically life if they are deemed insane (in which case you are transported to a mental hospital, from which you will usually not be released unless you confess to the crime), for crimes that they may never have actually committed. This is as serious a violation of human rights as the sexual abuse to the victim.

Now in the Netherlands there are pretty harsh guidelines on how police should be handling sexual abuse allegations in situations of power, including institutional care. These guidelines were introduced at the advice of Wagenaar and other legal psychologists, to minimize the risk of false accusations. Not all police officers, let alone all potential victims, are aware of these guidelines, yet not following them can lead to finding Wagenaar in the courtroom testifying that there is a risk that the accusation was crafted through dubious processes of collaborative storytelling or other forms of suggestion. This would be a potential problem for the genuine victim, because it essentially comes down to polished disbelief.

Unfortunately, the guidelines are not known to every police officer, and if they are, they may not be followed. It should, for example, be made rather explicit that false accusations are a serious offence. This comes across rather dehumanizing if we start from the presumption that victims don’t lie – but then again where is the presumption of innocence for the suspect? Unfortunately, more dehumanizing than being told by a police officer that you should really be telling the truth and that false accusations have serious consequences, is having an expert witness shot your accusation to pieces because of guidelines you had no knowledge of. I happen to know the guidelines, but should I ever be sexually abused in a situation of power, such as at my institution, chances are I would not recall them.

Beyond this, institutions often start investigations of their own, that run an even greater risk of suggestion than sloppy police investigations. These lay investigations are not possibly always motivated by genuine concern for the victim, but more so by concern for the institution’s reputation. You know, if sexual abuse is suspected and the suspected perpetrator is fired and the alleged victim provided with some kind of excuse for counseling, everything is fine, huh? Well, except if any party intends on filing criminal charges, in which case one may be stuck in the legal disbelief trap.

For anyone interested in W.A. Wagenaar, he is emeritus professor of legal psychology at Leiden University in the Netherlands. To my knowledge, there is one book in the English language published from him. I haven’t read it, and I am not sure whether you could access it in other countries. However, quite likely every country has its legal psychologists who write about similar cases. Anyway, the English-language book by W.A. Wagenaar and H.F.M. Crombag is entitled The Popular Policeman and Other Cases and was published by Amsterdan University Press, Amsterdam, Netherlands, in 2005.

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Neurodiversity Shouldn’t Be Exclusionist

MJ of Autism Jabberwocky had a post up recently commenting on the seemingly recent cracks in the neurodiversity “movement” that apparently surfaced through Michael John Carley’s and others’ Aspie exclusionism.

First of all, let me tell you, these cracks were always there. “Neurodiversity” has never been a unified movement. It is an ideology of acceptance and respect for human and civil rights regardless of neurotype. Neurodiversity as an ideology has nothing to do with how well someone can live a “productive” life by neurotypical standards if provided with certain accommodations. It has nothing to do with whether we are the next step in evolution, somehow superior to neurotypicals, whether autism causes us to possess strengths, or whether it is a disability. It has nothing to do with whether certain current or future treatments for autistic symptoms are necessary or desirable. It has nothing to do with forbidding any research on autism.

All of these issues and many more are under debate within circles of people who all claim to support neurodiversity. In fact, if the so-called “neurodiversity movement” truly was what MJ and other people outside of, and even within the “movement” see it as, I would not have considered myself a part of it. I can see in this case why MJ and others would argue with autistics who claim all autistics can have jobs and live independently if just being valued for who they are, with autistics who say autism is not a disability, or with autistics who think any and all treatments for autism symptoms and any and all research on autism should categorically be terminated. I argue with autistics who hold these opinions, too. I just don’t believe that is what the essence of the neurodiversity ideology is: as MJ correctly points out, it is an ideology of acceptance regardless of neurotype. Stop presuming devils in details that do not reflect the esseence of neurodiversity. These details may’ve been added by individual supporters, or even groups of supporters of the neurodiversity ideology. They are not the ideology itself.

So what is the ideology of neurodiversity? As I said, its essence is the idea that all people have the fundamental right to be accepted and have their human and civil rights respected, regardless of their neurotype. This right cannot by definition be conditional. For this reason, there is no logic in saying neurodiversity excludes your child. It doesn’t. People may exclude your child through the arguments they use to base their own right to acceptance regardless of neurotype on. This seems to be somewhat intrinsic to people involved in any kind of social justice activism, and I am probably naive for thinking it can be avoided: if it can be avoided in our blog or forum posts at all, it certainly cannot be avoided in real life. Anyone, after all, myself included, has some privilege over other people. But is that a reason to consider the entire social justice fight, in this case the neurodiversity fight, meaningless? I don’t think so.

To make somewhat of a comparison, white women at least used to erase black women in the fight for women’s rights. Does this mean that black women are somehow not suited for women’s rights, or that the entire women’s rights movement is bad? Of course it does not. It means large groups of white women were excluding black women through teh arguments they used in defense of their own rights. Similarly, if I, exercising my relatively “high-functioning” autistic privilege, erase your child through the reasoning I use to base autistic acceptance on, point it out. Do not use my, or anyone else’s, erasure of your child as a reason to discard the entire ideology of acceptance, or to decide that it is not for your child. The conditional nature of some pro-neurodiversity arguments may not suit your child, but this means these arguments are exclusionist, rather than that your child does not have the same rights we do.

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Dear Exclusionist Aspies

I hate the label of Asperger’s Syndrome. I have some trouble with the official definition, that doesn’t fully acknowledge the reality of some problems faced by some people with Asperger’s, including me. For example, you have to dig very deeply into the details of the DSM-IV criteria to notice that self-help difficulties can actually present in adults, and that “no significant delay in language development” merely refers to one’s ability to speak by the age of three, rather than to actual problems with access to language, or some forms of language or language on some subjects, that might arise in older children or adults. These problems are all minor enough that I can deal with them. There are more important problems in the DSM criteria, including DSM-V, of the entire autism spectrum, such as the lack of recognition for cognitive and sensory differences in favor of increasingly more stringent social communicative criteria.

Why I do hate the label of Asperger’s, however, is not related to any formal definition of it at all, but to the popular culture definition of Asperger’s, that reduces us to Einsteinian accomplishment. I am not Einstein. I will never be Einstein. If for no other reason, then because I hate physics. Stop comparing me to Einstein, about whom we will never know whether he was truly autistic or not. Stop comparing me to any other presumed Aspie in history, or any presumed Aspie genius in the present day. Even if they are all Aspies, I do not share all characteristics with them, and even if I did, they’d still live in different circumstances from mine.

I don’t want to be told that I can only be proud of my “Aspie” self if I am like Einstein, or like any of the other celebrity or historic “Aspies” populated by pop “Aspie” culture. I don’t want to have to prove in any way that I earn the right to be accepted as a person with autism. Neither should any “lower-functioning” autistic.

I used to tell autism advocates that elitist autistics are extremely rare. That is until I realized that maybe they aren’t, only they don’t refer to themselves as autistic. Michael John Carley and Liane Holliday Wiley, whose books are populated as insights into Asperger’s, and a large number of Asperger’s people on forums, may not exactly be using Aspie superiority tropes, but they certainly more or less say that Asperger’s people really should be able to accomplish great things. Well, what if I don’t? What if I dropped out of university two months into it? What if I’ve been residing in an institution for over two years? Remember, Asperger’s Syndrome is my official diagnosis, so you can’t erase me from the “Aspie” community unless you amend the criteria for Asperger’s – in which case maybe you should be calling for its removal from the DSM anyway. You cannot distance yourself from me.

And even if you felt that, because I don’t wear adult diapers or head restraints, I meet your conditional criteria for inclusion in an acceptable “Aspie” community, I wouldn’t want to. Your “Aspie” community would still be exclusionary even if it didn’t exclude me personally. I don’t want to have to base my right to be accepted on some criterion that someone else might not meet. Exclusionist neurodiversity is not neurodiversity at all.

I am autistic. I mean this to incude the entire autism spectrum, including what is now diagnosed as Asperger’s. I don’t know yet where on the spectrum I will be diagnosed in 2013, but quite frankly I don’t care. If I am diagnosed as being “mild”, and there will be a community of “mild autistics” that explicitly excludes those diagnosed as “severe”, I will not consider myself a part of it. In fact, if I can give you, elitist and exclusionist Aspies, some advice, keep calling yourselves “Aspies”. There is nothing that forbids you from doing so once DSM-V is out. But don’t complain that we are excluding you. You are welcome in the autistic community no matter where on the spectrum you fall – and actually regardless of your DSM-IV or DSM-V diagnosis or whether you have one at all -, but please, if you want to be included yourself, don’t exclude someone else based on an arbitrary assessment of their “functioning”.

Other autistics I’m aware of (including people diagnosed with Asperger’s) who have called people out on Aspie exclusionism before I did:

• Bev at Square 8
• Clay at Comet’s Corner
• Amanda Baggs at Ballastexistenz
• Chaoticidealism at Reports from a Resident Alien
• abfh at Whose Planet Is It Anyway?
• Sarah at Cat in a Dog’s World

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Crossdressing in DSM-V: Stigma Means You’re Mentally Ill

Helen G of Bird of Paradox had a roundup on proposed DSM-V criteria relevent to trans people. Because she has said everything that I could about gender identity but much more eloquently, I am not going to repeat that. However, one thing I did notice, and that I hadn’t noticed when looking at the sexual and gender identity disorders section myself, was that transvestic disorder (formerly “transvestic fetishism”) will still be in DSM-V, only with a rather unusual twist of logic: if the crossdressing does not cause significant distress, it is no longer an illness. It is still a paraphilia, but the DSM-V drafting committee invented the fancy, new word “paraphilic disorder” for those whose paraphilia does cause distress.

Of course, the unusual twist of logic is not in the distinction between distress and no distress: if something doesn’t cause significant distress (or impairments in functioning), it should not be diagnosed as a psychiatric illness. It still baffles me how things that aren’t a psychiatric illness, can be in the DSM, but with regard to paraphilias, the motive is that they are relevant for research. In other words: No, you’re not mentally ill, but you are so interesting we would like to keep you for our research, okay?”

However, what really surprises me is that, when a paraphilia does cause distress, it is a mental illness, without regard for the obvious nature of much distress faced by crossdressers (and other people who do not conform to the norms for gender expression or sexual attraction). Many people may not experience significant distress from the fact that they like to crossdress, or even from the fact that they experience sexual arousal when crossdressing, but far more from outside discrimination and stigmatization. In this case, if no-one is stigmatizing you, you don’t have an illness. If you get stigmatized to the point of significant distress, that means you must have an illness. Am I the only one who thinks something is rather inverted here?

There is one minor improvement from DSM-IV, that really should never have had to occur: the DSM-V drafting committee has finally looked up the definition of a fetish in the dictionary. For this reason, you now can only be diagnosed with transvestic fetishism if you actually get sexually aroused from fabrics, materials or garments associated with crossdressing. However, that does nothing to change the fact that, of course, no risk-aware, consensual sex, let alone anyone’s sexual preference, is any psychiatrist’s business.

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