Neurodiversity

Time for this Elephant to Leave this Circus

Heaven, Hell, Purgatory, and Limbo.  Those were the four big places to go.

The weirdest of all was Limbo.  Limbo was where they sent unbaptized babies.  The reasoning was, “It wasn’t their fault.” Yep.  Can’t see God if you’re not baptized, but you were too young to make the decision; “Whip ‘em into Limbo!”

[ethereal woo-woo sounds]  What could Limbo have been, man?  [more sounds]  W e l c o m e  t o  L i m b o  . . . .  [more woo-woo]

I think they’ve since cancelled Limbo; I’m not completely sure, but I think when they, uh, purged a few of the Saints, they called off Limbo, too.  Yeah.  Hope they promoted everyone, sent them to Heaven, you know, didn’t just cut them loose in space, right, you know.

Call him drug-addled and ill-informed if you like, but thirty-four years after George Carlin recorded that riff on things he was taught as a Catholic schoolboy, that portion of the Vatican’s metaphysical holdings known since the 13th century as “Limbo” was in fact up for liquidation.  A pair of BBC News articles from October 2006, Vatican to review state of limbo, and How can limbo just be abolished? explain that the Church’s international Theological Commission was in session and that the future of Limbo hung in the balance.  The following year, the Commission released a document which essentially punted on the question. Like Carlin, they were “not completely sure,” though a NYT headline at the time misleadingly read, Vatican City: Pope Closes Limbo.

All of which provides a rich background, I think, against which to view the recent news that the Asperger’s diagnosis may not appear in the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM).  Even the BBC reporter poses a question which is startlingly apt for the current situation.  I want to get to that question, but first let’s look again at those opening quips.

The office of jester, which Carlin often occupied, was originally a position of service to royalty.  The jester’s job, if he is not shirking, hedging, or acting as a mere comedian, is not just to say the things no one else is allowed to say, but to speak truth to power in full view of the assembled court—regardless of whether the presiding royalty wants to listen.  It’s no job for the faint of heart.  So what truth if any was George Carlin speaking, and to what power?

A devout Catholic mother who is grieving a stillborn infant clearly is in no position of power; the status of Limbo and its residents matter a great deal to her, and it would only be cruel to jest about her baby’s soul having been “cut loose.”  There’s not much funny there, save for the contrast between the eternal verity that vulnerable, grieving Catholic parents might believe Limbo to be—and the fact that such a “verity” exists thanks not to God’s Laws, but to Robert’s Rules of Order, to an up-or-down committee vote.  The truth Carlin was speaking, and that the Theological Commission’s report had to tap-dance around, was that Limbo is and always has been a “social construct,” a thing man-made rather than divinely ordained.

Simply put, so is autism.  For the psychiatrists who are revising the autism diagnosis in the DSM, this is a delicate moment, requiring a similarly impressive tap-dance.  They need to put across that some of what they produce may be a mere social construct, subject to the changing demands of the times … but not all of it. Tricky, tricky. From the BBC News article, How can limbo just be abolished? we read:

But there are those who argue that [Limbo] is not simply a “hypothesis” that can just be swept aside; that the notion that unbaptised children do not go to heaven has been a fundamental part of Church teaching for hundreds of years.

This point is echoed virtually verbatim by Temple Grandin, recently interviewed by the NYT, which summed up her perspective as “… Asperger’s [is] too well established to be thrown overboard.”

Back to the BBC article, the reporter goes on to ask the question at the heart of both situations, “Then, of course, there is the argument that if this can be abolished, what else is disposable?”

Bingo.

I’ve been thinking here about the story of the sightless men and the elephant, which Wikipedia has as follows:

In various versions of the tale, a group of blind men (or men in the dark) touch an elephant to learn what it is like. Each one touches a different part, but only one part, such as the side or the tusk. They then compare notes on what they felt, and learn they are in complete disagreement. The story is used to indicate that reality may be viewed differently depending upon one’s perspective, suggesting that what seems an absolute truth may be relative due to the deceptive nature of half-truths.

Kanner and Asperger, of course—creators of the social constructs known, respectively, as classic autism and Asperger’s syndrome—were two of those “men in the dark.”  Even as that darkness has given way to a dawn foretold by Asperger, however, so many others turn their attention toward autism and still report finding only disability and impairment.  Certainly where the DSM is concerned, Hans Asperger stands alone; though his name may remain as a diagnostic category, what will never appear there is his far more well-rounded perspective as touched upon by Uta Frith in Autism: Explaining the Enigma:

The term “autistic intelligence” was coined by Asperger. He believed that autistic intelligence had distinct qualities and was the opposite of conventional learning and worldly wise cunning. Indeed he thought of it as a vital ingredient in all great creations in art and science.

Which brings me to the only thing I can add to the discussion about the prospect of seeing Asperger’s syndrome folded into the DSM’s classic autism category.  Whatever kind of elephant autism may be, a Manual of Mental Disorders is by definition incapable of seeing it whole, or of defining it as anything beyond a burden. It’s time for this elephant to leave this circus, to move out of mental health Purgatory, out of a manual whose proper business is “mental disorders” and into bigger, nicer, friendlier digs.

Surely there are enough competent professionals—speech and language experts, cognitive psychologists, educational psychologists, among others, and this time let’s not leave out actual autistic people—who would be willing and able to create, say, a “neurodiversity manual” containing guidelines upon which service providers and insurance companies can base their billing codes.  Removing the divisions that come of having multiple DSM diagnoses for autism is all well and good.  As a stopgap, I hope it happens.  Meanwhile however, “a vital ingredient in all great creations in art and science” continues to be pathologized and stigmatized by its inclusion in our manual of mental disorders.

This arrangement has not been divinely ordained; it can be changed.

What individual, society, or civilization operates anywhere near its fullest potential under such a handicap?

We need autism—all of it, not just its named variants—out of the DSM.

related:  If I Could Rewrite the DSM-IV Criteria for Autism

Mark Stairwalt on 11/13/09 in featured, Politics | 6 Comments | Read More