Rebecca Hartong on Schaler
----- Original Message -----
From: "Rebecca Hartong"
To:
Sent: Friday, July 22, 2005 5:20 PM
Subject: Comment for Szasz Blog
In regard to the 7/22/05 post "Questioning Mental Illness" --
I listened to the Lehrer show interview and found it interesting. I'm
curious how Dr. Schaler explains something like autism. Brain disease?
(Are there diagnostic laboratory tests that can be performed to detect
autism?) Or is it a freely chosen behavior?
---
Rebecca Hartong
Cf. http://wnyc.vo.llnwd.net/o1/bl/bl072205c.mp3
Dear Ms. Hartong:
Look in a standard textbook of pathology and see if autism is listed there.
If it is not listed, ask a pathologist why it is not included. If it is
included, then autism refers to a disease. There are specific physical
signs that meet the nosological criteria for disease classification. I
would be surprised if these are well defined and predict the label of
"autism".
All behavior is freely chosen, there is no such thing as involuntary
behavior. Behavior means mode of conduct; deportment. A seizure, for
example, is not considered behavior. It is a neurological reflex. Autism
is generally regarded as a developmental disorder, not a mental illness or a
disease. Children labeled autistic have difficulties learning certain
cognitive tasks; they generally do not display the kind of psychological,
emotional, and social competence necessary for self-sufficience, autonomy.
Do they do things they want to do? Of course. Does their behavior seem
irrational, self destructive, etc. at times? Certainly. Can behavior be a
disease? Never. Diseases are only of the body. This said, I am no
specialist on what is labeled autism.
Thanks for writing.
Jeff Schaler
Jeffrey A. Schaler, Ph.D.
Department of Justice, Law and Society
School of Public Affairs
American University
4400 Massachusetts Ave., NW
Washington, DC 20016-8043 USA
Office telephone 202.885.3667, cell phone 240.460.0987
E-mail: jeffschaler@attglobal.net Home page: www.schaler.net
http://spa.american.edu/listings.php?ID=68
posted by Jeff Schaler @ 8:45 PM
4 comments
4 Comments:
Jeff,
I'm surprised at your answer. I assume that autism is an idiopathic brain disease, like migraine. No doubt there is a great deal of diagnostic overreaching and wrongheaded theorizing, but that doesn't negate the presence of real autistic disease (in some cases) any more than did the misdiagnosis and mistreatment of epilepsy. It may well be that the term "autism" is an eventually foresaken misnomer, that there are various causes -- such as viral and metabolic, and that some of what is labeled autism is not disease.
I agree that there should be pathological evidence of disease, but it isn't unheard of for the evidence to be hard and slow to come by, especially in the brain. It is unfortunate that "autism" has fallen into the clutches of psychiatry, just as it was that epilepsy did and migraine still does.
Surely not all behavior is freely chosen. When a person gets Alzheimer's, a brain tumor, or an injury to the brain, involuntary behaviors can result, even to the extent of obviating responsibility.
Nicolas,
It appears you did not read my words carefully. A disease is a lesion of the body. I asked the writer to inquire as to whether specific lesions, chemical imbalances, etc., the criteria necessary for disease identification and classification, are identified and included in a textbook on pathology. If this is not the case, then no disease is identified and defined. These are not my criteria, they are the criteria pathologists use for disease classification.
I then wrote: ” I would be surprised if these are well defined and predict the label of ‘autism’.” Again, if they are, then a disease is identified and defined, described. As you can also see, I said “I would be surprised if these . . . predict the label of ‘autism.’” What I mean by this is, can we tell who has been labeled “autistic” and who is not autistic based solely on these disease descriptions with an accuracy greater than chance?
I am just asking a question and saying I would be surprised if such a prediction would be so accurate. For example, people talk about different structures and functions in the brains of people labeled schizophrenia. These differences cannot predict who is labeled schizophrenic and who is not. That is relevant and important to the existence “of real autistic disease.” Perhaps such lesions will be discovered and predict what we call “autism”. But I don’t think that is true today. Again, I’m not an expert on what people call autism.
We generally speak of autism as a developmental disorder, meaning there are cognitive difficulties and impairments. A person who is retarded scores within certain ranges on an IQ test--which is socially constructed--and we categorize people in terms of different types of retardation by the extent to which they can live and function independent of supervision and assistance. Can they learn to speak, characteristic of “profound” retardation?
Perhaps there are, as you write, “various causes—such as viral and metabolic”, causes for cognitive and perceptual impairment. But what are the nosological criteria for the disease one might refer to or classify as “autism?” Why is it or is it not classified as a disease by pathologists? That is all I am asking.
Moreover, I’m not doubting, as you seem to be suggesting, that a disease called “autism” might not be discovered, defined, described, but again these would be physical criteria, lesions, specific chemical imbalances, etc.
Look up the meaning of "autism" on www.dictionary.com or, see this definition at http://www.nlm.nih.gov/medlineplus/mplusdictionary.html :
"Medical Dictionary
2 entries found for autism. Select an entry and then click 'Go'.
autisminfantile autism
Main Entry: au·tism
Pronunciation: -tiz-m
Function: noun
: a developmental disorder that appears by age three and that is variable in expression but is recognized and diagnosed by impairment of the ability to form normal social relationships, by impairment of the ability to communicate with others, and by stereotyped behavior patterns especially as exhibited by a preoccupation with repetitive activities of restricted focus rather than with flexible and imaginative ones"
Or this definition from Stedman's:
"autism
Pronunciation: (aw'tizm)
A mental disorder characterized by severely abnormal development of social interaction and verbal and nonverbal communication skills. Affected individuals may adhere to inflexible, nonfunctional rituals or routine. They may become upset with even trivial changes in their environment. They often have a limited range of interests but may become preoccupied with a narrow range of subjects or activities. They appear unable to understand others' feelings and often have poor eye contact with others. Unpredictable mood swings may occur. Many demonstrate stereotypical motor mannerisms such as hand or finger flapping, body rocking, or dipping. The disorder is probably caused by organically based central nervous system dysfunction, especially in the ability to process social or emotional information or language. Etymology: G. [autos,] self"
[http://www.emedicine.com/asp/dictionary.asp?keyword=autism]
Now, I’m afraid you are quite mistaken and in error when you write “Surely not all behavior is freely chosen. When a person gets Alzheimer's, a brain tumor, or an injury to the brain, involuntary behaviors can result, even to the extent of obviating responsibility.” A person with Dementia of the Alzheimer’s Type (DAT) still BEHAVES and his or her behavior is still a choice. The disease affects a person’s behavior, just as heart disease affects a person’s behavior, etc. Behavior means mode of conduct, deportment. There may be involuntary reflexes that we attribute to disease, however, these are not, as I have always maintained, behavior.
A seizure is not a behavior. Still, a person with DAT BEHAVES and his or her behavior is a choice. A person with Parkinson’s behaves, perhaps he walks backwards in order to get to where he wants to go; or, perhaps he starts singing when he gets “stuck” in a doorway, and then he can move. But he still BEHAVES and behavior is still a choice.
Why might we ask a person with DAT what he prefers to do? We respect his or her right to choose. This doesn’t mean he can drive a car responsibly. A person with Parkinson’s may be very depressed, for good reason, about his disease. He is unable to do certain things. We ask him if he would like to try a drug that changes his mood --doesn't treat a non-existent disease called "depression"--he may find it beneficial. We ask his permission. He says yes or no, perhaps because he trusts a family member. Still, there is behavior, albeit it is affected by his disease. Nevertheless, behavior is a choice.
There is no such thing as an involuntary behavior. Strictly speaking, “involuntary behaviors” cannot "result". People choose and they may not comprehend the consequences of their behaviors. We may hold them less responsible for their behaviors as a result, and limit their freedoms accordingly, just as we do with children. Children behave, yet we hold them to a different standard of responsibility than we do adults, and we limit their freedom accordingly, in part because they do not have the capacity to comprehend the consequences of their behavior, and in part because they are not producers, capable of living on their own. They are dependent, economic parasites. People who are sick and very old are also legitimate dependents, a type of parasite, too. We tolerate their dependency, in part, because it is time limited. They will either get better or die. True, some are chronically dependent. Still, they make choices, perhaps to comfort themselves one way over another.
If it’s behavior, then it’s voluntary. If the movement is involuntary, then it’s not behavior.
I hope this is clearer now.
Jeff
The layman and even the physical scientist/engineer's use of the word behavior is more along the lines of: behavior is any observable change in an object, regardless of its source.
Jeff writes: "People choose and they may not comprehend the consequences of their behaviors. We may hold them less responsible for their behaviors as a result, and limit their freedoms accordingly, just as we do with children."
Isn't that exactly the paternalistic psychiatric argument we should be opposing?
If behavior is always voluntary, then should we really limit their freedoms, or hold them less responsible for their actions?
If reflexes, as opposed to behavior, are involuntary, then aren't they the actions which deserve less freedom and responsibility?
What criteria should be used to distinguish voluntary behavior and involuntary reflexes, so that a person's freedom to behave is not infringed, and their responsibility for their behavior is not lessened, while simultaneously preventing their reflexes from causing harm to others (or to themselves if they sign an advance directive)?
That seems to be the central psychiatric question.
EEG or other evidence might reveal the source of involuntary movements, but if this kind of physical evidence is not forthcoming, how can we justify depriving freedom of movement?
Can responses to external stimuli be considered an adequate differentiator between behavior and reflexes?
At our present state of knowledge, I would guess not.
Does the answer to that question depend on the metrics used, such as whether physical lesions or electrochemical imbalances are found in the body, as opposed to subjective judgments of external bodily movements and vocal oscillations?
Jeff: Important points and questions by Lee. Thank you. I reply after each paragraph below.
Lee: “The layman and even the physical scientist/engineer's use of the word behavior is more along the lines of: behavior is any observable change in an object, regardless of its source.”
Jeff: I understand. The term behavior is applied to things. When we speak of behavior in relation to people we mean conduct, deportment. Behavior is volitional, governed or the expression of the voluntary—somatic—nervous system, mind, whatever you want to call it, as opposed to, for example, the autonomic or involuntary nervous system.
Lee: “Jeff writes: ‘People choose and they may not comprehend the consequences of their behaviors. We may hold them less responsible for their behaviors as a result, and limit their freedoms accordingly, just as we do with children.’”
Isn't that exactly the paternalistic psychiatric argument we should be opposing?”
Jeff: It is when the paternalistic argument is applied to adults. As I describe in my article entitled “Moral Hygiene,” at www.schaler.net/moralhygienebyschaler.pdf , there are three conditions or situations where we treat people without consent: When they are literally unconscious, literally children, and literally contagious. Those three conditions or situations are twisted by psychiatrists to justify “treating,” that is, coercing, adults for psychiatric “illness”: The person is alleged to be lacking “insight” into his condition, which means the person disagrees with the psychiatrist, this is metaphorical unconsciousness; the person does not take care of himself as an adult, acts “like a child,” thus, a metaphorical child; and the person is said to be “dangerous to others,” thus, the metaphorical equivalent of contagious.
But I am speaking of literal children in the quote above. And, when people are dependent by virtue of literal disease, we may limit their freedom; just as we may limit their freedom when they are very old and necessarily dependent on others. This is at times a very difficult call, which is why we try to reason and be sensitive with someone who has, for example, DAT, and we may ask them not to drive. People can demonstrate incompetence, for example, a person who is accused of a crime may be incompetent to stand trial, that is, he doesn’t understand the charges brought against him, is not able to assist counsel with his defense, doesn’t understand the proceedings of the court. But psychiatric diagnosis and “illness” should not have anything to do with this.
A person with epilepsy may drive only on condition that he or she takes medication to prevent seizure. We may hold him to a higher standard of responsibility if he chooses not to take the medication, thereby endangering others if he drives. If he chooses not to take his medication, his freedom to drive may be restricted. If he did not know he was seizure prone, drives, and harms someone else we hold him to a lesser degree of responsibility.
Lee: “If behavior is always voluntary, then should we really limit their freedoms, or hold them less responsible for their actions?”
Jeff: These are difficult lines to draw, I agree. All I am saying is that a person with a devastating disease still “behaves,” and that behavior is voluntary. Look at the late Christopher Reeves: His ability to do many things was obviously limited by the injury to his spinal column. Still, he behaved, he spoke, he didn’t speak, we admired his courage and perseverance, all expressions of behavior, volition, choice, etc.
Lee: ”If reflexes, as opposed to behavior, are involuntary, then aren't they the actions which deserve less freedom and responsibility?”
Jeff: Yes, Cf. my comments about epilepsy and driving above. Still, responsibility may vary depending on knowledge. A person falls asleep at the wheel, crosses the yellow line, and kills people in an on-coming car. He tells the judge he has sleep apnea, is deprived of REM sleep at night, and thus can’t control his tiredness during the day. The judge said all of that may be true, didn’t disagree, and held him to a higher standard of responsibility, saying, knowing that you were especially prone to sleepiness during the day, you shouldn’t have been driving.
Lee: “What criteria should be used to distinguish voluntary behavior and involuntary reflexes, so that a person's freedom to behave is not infringed, and their responsibility for their behavior is not lessened, while simultaneously preventing their reflexes from causing harm to others (or to themselves if they sign an advance directive)?”
Jeff: Functions of the somatic and autonomic nervous systems. When someone knows he has epilepsy, versus doesn’t know it. When a person has a stroke while driving and it could not have been foreseen. Similarly with a heart attack, etc. Did a person choose, could a person have chosen, to bring on the activity for which he had no control, e.g., drinking beverage alcohol. Did the person choose to take a sedative and then drive, or was the sedative put in his drink unknowingly by someone else.
Lee: “That seems to be the central psychiatric question.”
Jeff: According to psychiatrists, with the way they twist the three literal conditions I mentioned, into metaphorical conditions. If psychiatrists were gone, there would be no “psychiatric question.” Psychiatrists are irrelevant when the power they are given by the state is taken away from them.
Lee: “EEG or other evidence might reveal the source of involuntary movements, but if this kind of physical evidence is not forthcoming, how can we justify depriving freedom of movement?”
Jeff: It is complicated and difficult at times. One consideration: Is the activity goal seeking? For example, someone chooses to steal, murder, etc. The delusions of a person with central nervous system disease are usually characterized by cognitive deficit, the person has increasing problems with short-term memory, performing certain calculations, etc. The delusions of a person labeled “mentally ill” are usually characterized by false claims.
Lee: “Can responses to external stimuli be considered an adequate differentiator between behavior and reflexes?”
Jeff: It depends. If I’m clubbed on the head from behind while driving, fall forward and my car careens out of control as a result, then yes.
Lee: “At our present state of knowledge, I would guess not.”
Jeff: Some are more obvious than others. Generally, these aren’t at issue when people are deprived of liberty because of alleged threat to self and others. One, a person has a right to endanger his own well being, his body is his property. Two, the state should not be able to deprive someone of liberty because some think he will commit a crime. That is rule of man, arbitrary, no due process, etc.
Lee: “Does the answer to that question depend on the metrics used, such as whether physical lesions or electrochemical imbalances are found in the body, as opposed to subjective judgments of external bodily movements and vocal oscillations?”
Jeff: Sometimes. I suspect more in relation to possible harm to others, and this is demonstrated by cognitive impairment and incompetence in certain areas.
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