Sense and nonsense about Asperger syndrome
This is one in an occasional series of essays about issues in psychiatry and mental health, in which the author has an interest; he is not a psychiatrist but he has known many psychiatrists as friends and colleagues and he has studied their discipline with care as it overlaps substantially with his own academic origins that are in philosophy. This article is about what many people imagine to be a form of mental illness that for some time carried the name "Asperger syndrome"; but in fact this author will argue that it is not an illness at all, if it is properly understood. Rather it can be a mark of great mental brilliance, and the label "Asperger genius" might be more appropriate than "Asperger syndrome". Unfortunately social stigma associated with the practice of psychiatry has traditionally hampered the understanding of this mental condition, including its confusion with a rather different condition, Autism Spectrum Disorder, which according to contemporary psychiatric standards Asperger syndrome is supposed to be considered a part of and the label Asperger syndrome is now officially disapproved of. In this author's admittedly lay view, this contemporary approach of merging Asperger syndrome into Autism Spectrum Disorder betrays multiple confusions. Here we try to make sense of it all.
Autism Spectrum Disorder is asserted to be a neurodevelopment disorder although it is not obvious that this is actually true. Nobody really knows what causes autism. Autistic people suffer from an inability to form social relationships in certain ways although it is not really understood exactly what inhibits them. The common theme appears to be that they have trouble understanding the emotional reactions of others. But that can be said of a lot of people; it does not make them all autistic. The other distinguishing feature of autistic people is that they tend to have restricted interests. But again, not every stamp collector is autistic. Autistic people tend to be eccentric, because they are interested in only one thing and do not understand that acting differently from other people may cause others to shun them. But again, it would be an outrageous leap to say that all eccentric people are autistic.
Autism is in fact a spectrum, like all psychiatric qualities. And not every position on that spectrum is a disorder. Indeed the very label autism spectrum disorder is a harmful one and labels like this have contributed to social stigma against people who are a little eccentric or different but in fact are not mentally ill at all. We are each and every one of us a little bit autistic to some degree. Nobody can honestly say that they have never felt embarrassed or awkward in social interactions; nobody can say that they do not have hobbies or specific interests. In this author's view the greatest contribution to the public weal that the climate change activist Greta Thunberg has made is to admit publicly that she is autistic, something the vast majority of people are ashamed to do, and thereby remove the stigma associated with a condition that undoubtedly affects a very substantial proportion of the population but in most cases is not sufficiently severe to be characterised as a mental illness at all.
The World Health Organization defines Autism Spectrum Disorder in the following terms: "Autism spectrum disorder is characterised by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that are clearly atypical or excessive for the individual's age and sociocultural context. The onset of the disorder occurs during the developmental period, typically in early childhood, but symptoms may not become fully manifest until later, when social demands exceed limited capacities. Deficits are sufficiently severe to cause impairment in personal, family, social, educational, occupational or other important areas of functioning and are usually a pervasive feature of the individual's functioning observable in all settings, although they may vary according to social, educational, or other context. Individuals along the spectrum exhibit a full range of intellectual functioning and language abilities."
Hans Asperger was a pioneering Austrian child psychiatrist in the 1940's who noticed that some children had difficulty forming personal relationships with others; did not understand other children's gestures, engaged in one-sided conversations about their interests; and were clumsy. Nobody really knows what proportion of the population suffers from the "syndrome" that Hans Asperger identified but it was unfortunate that he described the collection of personality traits he identified as persisting together in children in such negative terms. What is overlooked in describing "Asperger syndrome" as it became to be known is that these qualities are also associated with a series of positive qualities, such as thoughtfulness; concentration; attention to detail; high intellect; independence of thought; and often high marks in school tests and examinations. Children (and adults) with Asperger syndrome are not necessarily sick or ill at all. They are just different, and often in very good ways. It is true that they can be loners, or pick their friends very carefully; that is because they are often very intelligent and thoughtful and take the utmost care in deciding who their friends and lovers ought to be.
A number of people have also described Asperger syndrome as a neurodevelopment disorder, but as with Autism Spectrum Disorder it is not clear that this is true and no specific neurological qualities have been identified with any scientific rigour to be associated with the condition. In time Asperger syndrome was assimilated into Autism Spectrum Disorder really just for the purposes of applying William of Ockham's maxim that entities shall not be multiplied beyond necessity. So-called Asperger syndrome has some common qualities with some aspects of conditions known as Autism Spectrum Disorder but in other ways it is quite different. The high IQ common amongst persons diagnosed with Asperger syndrome has nothing to do with Autism Spectrum Disorder; persons with the latter disorder may have high IQ's or they may have very low ones.
Asperger syndrome does appear to have strong genetic associations (i.e. it is passed down within families), but nobody really understands why.
It is said that children with Asperger syndrome are unable to read the emotional reactions of others; but this is not true either. A better way of characterising the matter might be to say that persons with Asperger syndrome have such high attention to detail that they observe every last detail in a counterpart's emotional reactions, and they observe so much that they are uncertain how to react. In time, they can teach themselves to overcome this and to engage in normal social interactions with people by filtering out the excessive information they observe by reason of their close attention to detail. Indeed for this reason people with Asperger syndrome are often extremely astute judges of character, precisely because they pay so much attention to the minutiae of people's expressions, body language, vocal intonation and all the other features of human behaviour that reveal what a person is thinking notwithstanding what they may actually be saying.
It is also said that people with Asperger syndrome are unable to lie. This is nonsense. The fact is that by reason of their intellectual focus, and their capacity to absorb ideas and sift them, people with Asperger syndrome far prefer the truth; they do not like people who lie; and they strongly prefer not to lie themselves. Asperger syndrome involves a sort of intellectual purism in which analysis and truth is valued. Nevertheless persons with Asperger syndrome can be extremely good liars if they want to be. That is because their attention to detail permits them to observe all the tell-tale signs of lying in other people; and to ensure that when they lie they do not copy these sorts of mistake.
People with Asperger syndrome possess great clarity of thought and they can absorb large quantities of information and distinguish sense from nonsense. They understand that good ideas tend to be simple ones, even if not expressed in simple ways; and they tend to have an independence of mind and confidence in their own rational clarity that enables them to put to one side the opinions prejudices and pressures of others to think in a certain way. They are able to synthesise complex ideas into simple ones, or to "see the wood from the trees" as it is sometimes said. For this reason they sometimes come across to others as arrogant, and therefore it is important for people with Asperger syndrome to practise and learn virtues of modesty and humility notwithstanding their often superior intellectual abilities. It is often said that the only way to treat Asperger syndrome is to train the patient; while we are of the view that this is not a syndrome and there are no patients, nonetheless the sort of training that will assist a person with Asperger syndrome in life is to train them in how to be modest and humble when working with others. Otherwise their intellectual accomplishments risk generating resentment in their friends and colleagues.
The capacity of persons with Asperger syndrome to concentrate on specific tasks may create a culture of extremely hard work as they like to focus on the task at hand and they are often perfectionists, continuing working until the job is done no matter how long it takes. Because they have energetic and sparkling minds that overflow with ideas, they often want to start working at strange hours as soon as new ideas or analyses come into their minds. For this reason they are often erratic sleepers and they may not always work to conventional time schedules. These sorts of habit require mutual comprehension. The rest of the world prefers to work to clear schedules and does not want to work to the long schedules of people with Asperger syndrome. Due to their abilities, people with Asperger syndrome often rise up within organisational structures and adopt managerial positions. They then stand at risk of becoming tyrants as they expect everybody else to work as hard as they do. This is an error that a person with Asperger syndrome must constantly keep in mind. People with Asperger syndrome have an independence of intellect and thought that sometimes causes them to overlook the fact that organisations work by consensus and cooperation, and you need teams of people to be able to achieve the best results. Everyone has good qualities, and hard work and intellectual independence are two such qualities but not the only ones. A good team mixes people with these qualities with other people with different qualities.
People with Asperger syndrome are often people of particular principle. Their focus on intellectual purity and the pursuit of the truth may give them a certain integrity. They are often people who can be relied upon. They may be great sticklers for some things, such as being on time. They are often the sorts of people who arrive early to meetings, not the ones who arrive late. Organisations require such discipline, because without leadership by integrity and principle a culture develops of flaccid attention to detail and loss of focus upon the organisation's purpose. This applies in both the public and private sectors.
For this reason, people with Asperger syndrome are often leaders, setting the direction for an organisation or a movement - as long as they remember always to exhibit inclusiveness, to listen to the ideas of others, to engage with their colleagues, and to be sympathetic and understand that some others may find them intimidating.
Asperger syndrome is not a neurological condition - or if it is then there is no reliable evidence in favour of this assertion. It is a personality type. There are many personality types, each with their own advantages and disadvantages. We see no grounds for describing Asperger syndrome as a syndrome or an illness or a disease. There is appropriate treatment for it, as we have intimated, in the form of training to overcome some of the personality shortcomings that a person with Asperger syndrome may suffer from. Also people with Asperger syndrome may suffer from anxiety, particularly in earlier life, as they struggle to cope with the complexities of human interactions given their very high level of attention to detail. Anxiolytics may on occasion be prescribed to manage such anxieties; but that is the only pharmaceutical regimen that may be appropriate for people with this condition.
People with Asperger syndrome are often exceptionally kind, sensitive people although there are always a few psychopaths out there. They study other people carefully and are sensitive to their needs, fears and desires. We should be sensitive to them too, and that is what Greta Thunberg has so excelled in showing us. Let us cast off the stigma of psychiatry, and stop calling Asperger syndrome a mental illness at all. It is something quite different, and in many ways extremely positive.