Rain, autism, and the DOJ is here to help us.

View 720 Friday, April 13, 2012

Friday the 13^th falls on Friday this month.

Outside it is raining cats and dogs. I haven’t used that expression since – well probably since childhood, but I do recall it, and at one time it wasn’t all that unusual. I was recently reminded of it in a conversation with a friend who has an autistic child. While I think many cases of ‘autism’ are something else, this one was as real as it gets: the boy became fiercely hostile, inarticulate, frustrated, often violent, and was generally diagnosed as hopeless and retarded to boot. His father would not give up, and over years managed to cope; now the boy goes to school, and may well end up going to college. The times I have met him since his – I won’t say recovery because I don’t know what he recovered from – since he has been able to go to social events – he has been bright and well informed about subjects he is interested in. At ten he knew as much about Medieval history as most adults including some stories I didn’t know. He’s also polite and mostly respectful.

But his father tells of one day when the boy was still very much disabled. It was raining and the boy became extremely hostile, and managed to convey his disgust at being lied to. It took hours to find out what all that meant. His father had remarked that it was raining cats and dogs. And the boy looked outside and there were no cats and dogs. And thus he had been lied to. It took another hour to get across that this was an idiom, what the Spanish call a modismo. I am encouraging my friend to write up a detailed case history; we have at least this case of a diagnosis of hopelessness followed by a recovery that certainly would not have happened without the determined actions and extreme patience of the father.

Medicine used to advance through case histories. Detailed descriptions of everything – relevant or not – followed by detailed descriptions of treatments and their effects – could sometimes be compared to produce insights. One of the insights might be just what is relevant, which is not always obvious, which is why the case histories had to be detailed and include everything whether the describer thought it relevant or not. The textbook I had for abnormal psychology was the Henderson and Gillespie Textbook of Psychiatry which emphasized case histories and minimized theories. It was rare in the early 1050’s; in that time most psychology books were written from the viewpoint of, and often in defense of, a theory, and there were many theories, most of them based on — well, on examination, on nothing much at all. There was Freud, whose theories of Id, Ego, and Super-Ego were pure smoke and air with no evidence for their existence in physiology – and which were based on ‘case histories’ many of which turn out to have been made up. There were others, many others. Jung, Karen Horney, Wilhelm Reich, Carl Rogers – I could go on and on. Most of them were supported only be case histories, and even assuming that the case histories were real, they were all recorded by observers looking through the lenses of theories.

Meanwhile non-Freudian psychiatrists had stayed with the case history methods of medicine or wandered off into the realms of shock therapy (insulin, electro shock, and some others too disgusting to mention) but about this time pharmacology developed new treatments. Lots of them. And there was enormous financial pressure, and legal pressure as well, to empty out the madhouses – oops, asylums – oops, psychiatric hospitals. When I studied abnormal psychology it was pretty well agreed that schizophrenia was incurable. It had for a long time been ‘dementia praecox’, as opposed to ‘senile dementia’, and neither was well understood, but one thing was clear: neither psychiatry nor psychology nor psychoanalysis nor anything else we knew how to do could cure it or even do much to assuage the symptoms, and all that remained was to lock them up for life. Some became fairly useful members of the psychiatric hospital community, some didn’t; but none of them got ‘treatment’ because once it was known that you were schizophrenic attempts at treatment were a waste of time. Yes, I oversimplify, but not by much.

And during this era came Dianetics, a synthesis of Jung (particularly the collective unconscious) and Korzybski’s General Semantics, both intellectually respectable (although oddly enough Jung more than Korzybski) by a science fiction writer named L. Ron Hubbard and espoused by A. E. Van Vogt. Dianetics was supposedly validated by Hubbard’s experiences with ‘cases’ but it turned out to be very difficult to find any of those clients, and the suspicion is that Hubbard, like Freud, made up or exaggerated some of them. Whether he did or not, his Dianetics treatment methods were fairly effective in comparison to the results of more traditional psychotherapies such as psychoanalysis, and training as a Dianetics auditor was enormously cheaper than training in traditional psychotherapy (much less psychiatry which required an MD before you could even start learning). Dianetics caught on just like Wells Saddler, and was enormously popular on college campuses until the AMA denounced Hubbard and Dianetics for practicing medicine without a license. But that’s another story.

My point here was that everyone, traditional psychotherapists of various schools, psychiatrists with their new bag of pharmaceutical tricks, Dianetics auditors – all recorded case histories if at all through the lenses of their theories. And then came the DSM, which may not have been intended as the standard for every mental practice but in effect became sol which practically forces practitioners to record their case histories according to already known patterns – when, as with autism, the problem may well be that we don’t know the patterns. Henderson and Gillespie, my abnormal psychology textbook (Henderson and Gillespie, Textbook of Psychiatry,7^th edition), has two index entries to ‘autistic thinking’, one for autism and for Aspergers none at all—nor is there any mention of ADD or ADHD. Now they spend a full quarter or semester on those matters. Last week’s New Scientist has a new item on how the autism rate in England has about doubled since the year 2000. And I am told that a sizable percentage of adolescents in wealthy school districts are being given drugs for various forms of ADD.

Now clearly something is happening; but what is not clear. The tendency is to classify as if we understood, but in fact we don’t. The only time I ever did anything in clinical psychology was when I worked with a local pediatrician on a couple of cases of bright young males who were not doing well in school. All I did was talk with them, and it was pretty clear that their problem was that they were bored stiff, and they didn’t know any educated adults who would have rational conversations with them. I could relate to that having grown up smart in a country environment during the war.

And now I am rambling. My point, if I have one, is that we need to get particulars before we generalize. I know this: my friend’s son was diagnosed as hopeless, and everything I have been told by professionals would agree with that; but he didn’t give up, and now the boy is likely to have a normal life and may in fact do a lot better than that. And if there’s one case that’s an exception to the rules imposed by the DSM there are certainly others. I’m encouraging my friend to write up this case history in as much detail as possible. We need a lot more of that. Including cases that didn’t turn out well.

And it has stopped raining cats and dogs. I even see a ray of sunshine.

I actually came up intending to write about The DOJ lawsuit against Apple. In theory this is supposed to be good for all of us, but I can’t help thinking that it’s really another step in giving Amazon a monopoly in the eBook market. I love Amazon. Most of my income comes through Amazon now, some direct to me, some to my agents, some from sales by my publishers – Amazon is enormously important to all writers. The major competition for Amazon has to be Apple. At the moment Amazon wants to lower the prices of eBooks – at least of best sellers – and was doing so by buying books from publishers, paying the publisher demanded price, and selling the eBooks at below that cost. Of course they couldn’t keep that up, but Amazon has traditionally gone for market share rather than profit – exactly the opposite of Apple, which has always put immediate profit above market share, and has always been striving to keep prices of Apple products high. A number of authors and agents talk about this in an article in today’s Los Angeles Times by Carolyn Kellogg. I’ll have more to say on this another time.

I’ve been putting it off, but I have to get back and finish my taxes. This evening I have a dinner with other writers and the winners of the Writers of the Future Contest, the weekend is filled with stuff, and Monday night is the tax deadline. I hate the notion of having to spend so much time proving to the government that I deserve to keep some of what I have earned.