dr who doesn't see what's there?

[Guest guest]

November 21, 2006

Cases

Like a Fish Needs a Bicycle: For Some People, Intimacy Is Toxic

By RICHARD A. FRIEDMAN, M.D.

It is practically an article of faith among psychotherapists that an

intimate human relationship is good for you. None other than Freud

himself once famously said that health requires success in work and

in love.

I'm not so sure. It seems that for some people, love and intimacy

might not just be undesirable but downright toxic.

Not long ago, a man consulted me about his 35-year-old son, who had

made a

<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/sui\

cidesandsuicideattempts/index.html?inline=nyt-classifier>suicide

attempt.

" I was shocked, because he never seemed depressed or unhappy in his

life, " the man said of his son. " He always preferred his own company,

so we were relieved when he started to date. "

He went on to tell me that he and his wife had strongly encouraged

their son to become engaged to a woman he was dating. " She was

perfect for him, " he recalled. " Warm, intelligent and affectionate. "

Everything seemed to be going well until, one day, the father got a

call from his son's girlfriend. She had not heard from the son for

several days, so she went to his apartment and found him

semiconscious in a pool of blood. He had taken an overdose of

sleeping pills and slit his wrists.

After a brief hospitalization, where he was treated for

<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/dep\

ression/index.html?inline=nyt-classifier>depression

with medication, he returned home and broke off the relationship.

Soon after, he moved to Europe to work but remained in frequent

e-mail contact with his family. His messages were always pleasant,

though businesslike, full of the day-to-day details of his life. The

only thing missing, his father recalled, was any sense of feeling.

I got a taste of this void firsthand when his son came home for a

family visit during the holidays. Sitting in my office, he made

little direct eye contact but was pleasant and clearly very

intelligent. He had lots of interests: computers, politics and

biking. But after an hour of speaking with him, I suddenly realized

that he had not mentioned a single personal relationship in his life.

" Who is important to you in your life? " I asked.

" Well, I have my family here in the States and some friends from

work, " he said.

" Do you ever feel lonely? "

" Why would I? " he replied.

And then I suddenly understood. He wasn't depressed or unhappy at

all. He enjoyed his work as a software engineer immensely, and he was

obviously successful at it. It was just that human relationships were

not that important to him; in fact, he found them stressful.

Just before he made his suicide attempt, he remembered, he had been

feeling very uncomfortable with his girlfriend and the pressure from

his parents. " I wanted everyone to go away, " he recalled.

Typical of schizoid patients, this man had a lifelong pattern of

detachment from people, few friends and limited emotional

expressiveness. His well-meaning parents always encouraged him to

make friends and, later on, to date, even though he was basically

uninterested in social activities.

" We thought he was just shy but had lots of feeling inside, " his

father told me.

That's what his son's therapist believed too. When I telephoned her,

she explained that she had been pushing him over the four years of

treatment to be more social, make friends and finally date. She

attributed his failure to do this in any significant way to his

underlying anxiety and low self-esteem. " With time, " she said

confidently, " I expect he'll make progress. "

When I got off the phone, I wondered if we had been talking about the

same patient. I found him calm, detached and self-confident about his

abilities and work.

His therapist apparently believed that no one could genuinely prefer

solitude and that there must be a psychological block preventing this

patient from seeking intimacy.

But after four years of weekly therapy the patient had basically

failed to reach any of these goals. You would think that for this

reason a therapist would question whether the treatment was really

the right type for the patient. After all, if your doctor gives you

an

<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/ant\

ibiotics/index.html?inline=nyt-classifier>antibiotic

that doesn't kill an infection, he or she should question the

diagnosis, the treatment or both.

Granted, psychiatric illnesses are generally more difficult to treat

than simple bacterial infections, but why should psychotherapy be any

less self-critical and self-correcting than the rest of medicine?

I had a hard time explaining all this to the patient's father.

Finally, I came up with an analogy that I had some hesitation about,

but since I discovered that both of us were dog lovers, I gave it a

try. I explained that some breeds, like Labradors, are extremely

affiliative; other breeds are more aloof and will squirm if you try

to hold them.

?You mean my son is detached by nature, " he said. " I guess we all

pushed him too hard to do something he couldn't do and didn't want. "

Emotional intimacy, it seems, is not for everyone.

<http://www.nytimes.com/ref/membercenter/help/copyright.html>Copyright

2006 <http://www.nytco.com/>The New York Times Company

[Guest guest]

What use/bother is that the Dr. didn't identify " autism "

by name, saying instead " schizoid personality " ?

Much more important is that he correctly identified

the _solution_, i.e. don't push, leave the guy alone !

If he identified " autism " then proposed ABA it would

have been any better ?

Thank you for thinking about this,

Mircea

[Jane Meyerding pointed out:]

> November 21, 2006

> Cases

>

> Like a Fish Needs a Bicycle: For Some People, Intimacy Is Toxic

>

> By RICHARD A. FRIEDMAN, M.D.

....

[Guest guest]

hi everybody, I'm kind of new here so please forgive me if I offend. Please be

gentle in your reply, if possible, as I don't do well with confrontations.

I am on disability because I am unable to hold a regular fulltime job. I am

faceblind, so I have trouble remembering who my boss is, who my coworkers are,

who are my clients/ students, etc. I have difficulty relating to others, am

easily overstimulated, easily disoriented, and need frequent rest breaks. I

have difficulty following " proper procedure " and make a lot of mistakes when I

have to do things the " proper way " rather than my way. On the other hand, I'm

very gifted in mathematics and music. My " official " diagnosis is schitzotypal

personality disorder, a diagnosis with whichI have never felt comfortable.

Recently my doctor agreed that a more accurate name for my difficulties is

Asperger's Syndrome, a form of autism.

Now I see here people are saying that autism is not a disability or disorder,

the problem is in the way the world sees us and treats us. So I am wondering,

I've been fired from more jobs than I care to think of, because of " not fitting

in " , " not following procedures " , " excessive absence " , " insubordination " , etc. (I

do a little work in the areas of my high ability. but nothing resembling a

fulltime job, and I work on my own terms on very limited hours, often on a

volunteer basis.) I was greatly relieved when the gov't agreed that I cannot

hold a job, and agreed to give me a small monthly pension. Otherwise I would be

literally out on the street, or else dead by now, of starvation, exposure,

and/or suicide.

I know some Aspies do well in areas such as academia, technology, and civil

service; I've tried to make a living in these areas but I am too unstable.

So now the official line in the Autistic Community is that autism is not a

disability and so I am not disabled? If I'm not disabled, how come I have so

much difficulty doing things that most people take for granted? How come I

can't hold a job? How come I can't function if I'm a little stressed or if there

is background music, things that most people seem to take in stride? How come

my hearing is more acute than most adult's, but I appear to be slightly deaf

because I have trouble understanding speech, almost as if English were a second

language? I could go on but you get the idea.

What about legal issues? If autism is not a disablity, am I still eligible

for a disability pension? If autism is not a disability, can we still ask for

" reasonable accomodations " in education and in the workplace, under the

Americans with Disabilities Act? What do we stand to gain, legally, by

demanding that autism not be considered a disability?

Since I've learned about Asperger's Syndrome, I find it a lot easier to ask

for various accomodations such as turn off the background music, let me rest,

let me have a little more time to learn my way around, help me when I'm

travelling, don't be offended if I don't recognise you or seem " remote " , don't

misjudge me if I don't make eye contact, don't be offended if I write you a

letter rather than talk to you, etc. People are usually willing to give me

these accomodations once I say I " have Asperger's Syndrome. " Now I find out

Ifrom this list that I'm not supposed to say I " have " anything, I " m supposed to

say I " AM autistic " or " AM an Aspie " . Only trouble is, people have some idea

what it means to " have Apserger's Syndrome " but they've likely never heard of

" Aspie " , and " autistic " sounds just like " artistic " in some regional dialects,

including mine. (Yeah, I'm artistic too, but that doesn't lead to problems like

being autistic does.) Will the Autistic Community be

very mad at me if I find it easier sometimes to say I " have Asperger's

Syndrome " ? Will I be kicked out, shunned, voted off the island?

On the other hand, I realise that I am not a " normal " person " underneath " my

autism; this is the way I am and I cannot imagine wanting to be " cured " . And I

realise that being autistic also carries certain strengths, such as sensory

hyperacuity, high pain tolorance, creativity, enhanced problem solving ability,

enhanced ability to concentrate, hypervigilance, and special talents in areas

such as math, science, and art. These traits have probably often contributed to

the survival of the individual with the genes carrying these traits, as well as

to the survival and prosperity of the group, at various times in human

evolution. So I can see that autism is not a " defect " in the same sense as

other human variations that are considered disabilities (eg, blindness,

lameness, heart trouble, severe allergies, etc) still, there is the problem of

our various sensory and social problems. If these problems are not

disabilities, what are they? Something for which society needs

to accomodate? But this begs the question. Why accomodate for something that

is not a disability? About the only analogy I can think of, is being

left-handed, which also requires certain accomodations and which is not

considered a disability. But the accomodations for autism are far more

extensive (and expensive) than those required for left handedness, so this

analogy doesn't really hold.

If I were not autistic I would not be me, I would not be someone else, I would

not be anyone or anything. But the fact is, I cannot hold a job, and I have

trouble doing things that most people seem to do easily. The catchall term for

these difficulties is Asperger's Syndrome, a form of autism. So why does the

autistic community not consider someone like me, disabled? And if I am not

disabled, what about people further along the autistic spectrum, who cannot

speak, who do not learn to wash or feed themselves or even use the toilet? Are

people like this considered disabled? If so, why? And if not, why not?

Someone please explain if you have the time and energy. I don't want to offend

anyone, I am trying to understand the groupthink here. Please explain gently,

if you can, as I don't take well to confrontations or people fussing at me, even

via computer.

Thanks -- Joni

---------------------------------

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things done faster.

[Guest guest]

> hi everybody, I'm kind of new here so please forgive me if I

> offend. Please be gentle in your reply, if possible, as I don't do

> well with confrontations.

Hello, Joni, and welcome.

There are others on this list who are far more knowledgeable and

qualified to comment about your questions regarding disability, and

hopefully, one or two of them will speak up. In the meantime, I will

offer what I can.

Like most people, you are presupposing something that we do not

presuppose: that a disability is a medical condition. Disability

advocates generally reject this notion, arguing instead that

disability is a social condition.

For example: your question about becoming distressed and disoriented

at work when other people are playing music. That isn't because you

have a medical problem, it's because you're working in an environment

that isn't tolerant of the fact that your auditory system works

differently from theirs. If they accepted your condition and turned

off their music (or listened to their music on earphones instead, or

what have you), you would not be having a problem at all.

This is why we find the notion of " curing " autism so offensive: the

non-autistics set up society in such a way that it works great for

them but greatly hampers us, then they argue that, because we cannot

function under their rules, we are defective individuals who need to

be corrected or eliminated. It would be like telling black people

that we should seek a " cure " for black skin in order to prevent all

the lynchings carried out by the Klansmen.

Most autistic advocates adhere completely to the social model of

disability and completely reject the medical model altogether. I,

myself, do not; I hold that the social model is largely correct but

that there are certain conditions that truly are medical

disabilities. However, the latter are much more the exception than

the rule. Your difficulties with background music are quite firmly

in the " social " category -- and, in fact, I would even go further

than that and argue that your auditory system is superior in many

ways to theirs.

As for autism being a " disability " , well, actually, it is -- but only

because our society makes it one. A good analogy would be the way

things used to be with paraplegics. Our society once rejected

wheelchairs so strongly that people confined to wheelchairs couldn't

even leave the house because of everyone staring, pointing,

whispering behind their backs, and so on. If they *did* leave the

house, they were constantly confronted with places that they couldn't

go because people with standard legs had the world set up for

themselves, with no consideration for others.

As paraplegic activists did their work, however, society changed.

They changed people's attitude toward paraplegia so that first,

staring and pointing came to be considered rude, and finally, people

today, when seeing someone in a wheelchair, hardly notice (except,

perhaps, to step out of their way or give them priority on

elevators). Prejudice was eliminated.

As far as " getting around " goes, the activists did a lot of work

there, too. The sidewalk curb was once the bane of paraplegics; now,

all sidewalks have those little ramps at the corners, and paraplegics

cross streets without even thinking about it. Adding those little

ramps probably increased the cost of building sidewalks by a small

amount, but the benefit for paraplegics was huge.

More importantly, though, something else happened: those little

ramps, which were originally installed for use by the wheelchair-

bound, are now used by everyone: people with strollers, luggage

racks, hand trucks, and so on. In fact, society at large benefits

far more from those ramps than wheelchair users. Here in the Metro

DC area, I see all kinds of people using them all the time -- I use

them a fair amount myself, mostly when I'm hauling heavy parcels to

the post office -- but I can only recall one occasion where I ever

saw someone in a wheelchair using one. In other words, when society

made accommodation for one small group with a particular difficulty,

everyone else greatly benefited as well; advocating for the disabled

is really advocating for everyone.

All this is just the tip of the iceberg... as I say, others are

better informed about this and more eloquent than I, so hopefully

you'll be receiving other responses soon.

--Parrish

<o>

[Guest guest]

Ok -- I think I'm getting it.

You're not saying autism isn't a disability (So you're autistic? That's not a

disability! Quit whining and try harder!); you're saying disabilities pose

questions better answered socially than medically.

Is it ok sometimes if I say " I have Asperger's Syndrome " rather than " I am an

Aspie " or " I am autistic " , especially when communicating my needs to NT's? I

simply find the former to be clearer and easier to say on my end and understand

on theirs.

I'm looking forward to other people's take on my questions, as long as you say

it kindly!

Thanks -- Joni

---------------------------------

Everyone is raving about the all-new Yahoo! Mail beta.

[Guest guest]

> You're not saying autism isn't a disability (So you're autistic?

> That's not a disability! Quit whining and try harder!)

Right -- in fact, I find the " try harder " view offensive in the

extreme, for so many reasons that it would be hard to know where to

begin in listing them, and it would take several hours of writing.

> you're saying disabilities pose questions better answered socially

> than medically.

For the most part, yes.

> Is it ok sometimes if I say " I have Asperger's Syndrome " rather

> than " I am an Aspie " or " I am autistic " , especially when

> communicating my needs to NT's? I simply find the former to be

> clearer and easier to say on my end and understand on theirs.

You would probably get a number of different answers to this. For my

own part, I prefer to say that I am autistic, even though my

diagnosis is Asperger Syndrome, for a few reasons. First, I don't

believe that AS is distinct from autism; second, even if I did, I

would say that my present diagnosis is actually incorrect; and third,

I believe I have a responsibility to do some consciousness-raising

when it comes to autism, although it does get pretty tiresome to have

to explain it again and again and again -- particularly with the

knuckleheads who insist, sometimes rather vehemently, that I am not

actually autistic, which *really* makes me angry (for basically the

same reasons as the " try harder " knuckleheads).

--Parrish

<o>

[Guest guest]

Hi Parrish and all,

You certainly raised a hot thread on this topic! It never really

occurred to me before but it does make sense. Gawd!!! Trying to

explain to NTs your own situation/plight is hard! What burns my hide is

how (it seems to me anyhoodle) that NT society will always be willing to

" roll out the proverbial welcome mat " for certain groups of people i.e.

gays, homeless, substance abusers while (once again, natch) us ACs are

ostracized, left out in the cold and often told by NT society " FEND FOR

YOURSELVES, SUCKER!! "

I hate to be such a pissed off Debbie Downer but the thing is, facts is

facts.

Wanda--Who never said as a kid she wanted to be part of the " career Blue

Vest Brigade "

http://community.webtv.net/tikigalharkins/LETSTALKASPERGERS

[Guest guest]

>

> to explain it again and again and again -- particularly with the

> knuckleheads who insist, sometimes rather vehemently, that I am

not

> actually autistic, which *really* makes me angry (for basically

the

> same reasons as the " try harder " knuckleheads).

>

> --Parrish

> <o>

Yeah, that's another area the public needs education on. Most

people when they think of autism they think of people at the

extremely impaired end of the spectrum. So if you can function well

enough to get into a conversation and say " I am autistic " , you're

obviously not. And they usually seem to think of children, as if we

don't grow up, or as if we somehow outgrow autism.

To most people " autistic " seems kind of extreme, like " blind "

or " deaf " . We got to educate them that there's a spectrum of

abilities within autism, or else come up with a new word that

communicates this. -- Joni

[Guest guest]

Joni wrote:

>To most people " autistic " seems kind of extreme, like " blind "

>or " deaf " . We got to educate them that there's a spectrum of

>abilities within autism, or else come up with a new word that

>communicates this. -- Joni

There are ranges of blindness and deafness, too. Come to think of it,

there are blind and deaf people who have had to spend a lot of time

explaining themselves in the same way many of us do. " Yes, I am

blind. But I have some vision that I can and do use for _____. " Or

" Yes, I am deaf, but I have some hearing that I use for ____. " The

next part has to be: " But I'm still blind [or deaf] and therefore you

cannot assume I will respond like a sighted [or hearing] person. "

Tedious, true. I don't agree that we need a new word, however. Part

of what I'd like us to be doing in *emphasizing* (rather than

rejecting) our commonalities with those who are perceived as

" extreme " or " severe. " When we do that, we (we who are allowed to be

out and around, talking to NTs) may be able to open the door a bit

wider for those who are perceived as too " extreme " to be part of the

(mainstream) community.

Jane

[Guest guest]

> I am on disability because I am unable to hold a regular fulltime job. ...

> So now the official line in the Autistic Community is that autism is not a

disability ...

> If autism is not a disablity, am I still eligible for a disability pension?

I don't think the " official line " (actually " popular consensus " -

- even though " popular " and " consensus " are almost anathema to

autistics) will significantly affect this. There are two

precedents:

1. the deaf community. I don't think public authorities point

to deaf culture as a reason to determine disability status.

2. ethnic minorities. Ethnic minorities consider themselves

socially disabled. Society's reaction is an attempt to offer

equal opportunity, rather than disability. Regardless, social

disability isn't considered a reason to dismiss the disability.

As to autism itself, a medical definition is different from a

legal definition. Legally (as far as social benefits are

concerned), the issues are proof and need; not cause and

pathology.

- s