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Comment by jmcgough | Hacker News Reader

Be careful about that kind of wording. I and friends who're on the spectrum don't consider it a "mental disorder". It's simply a physiological difference, one that theoretically can be tested for.

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> Be careful about that kind of wording

I have friends on the spectrum. I happen to agree that mildly autistic behaviour is more akin to a personality difference than a disorder.

That said, I don't think it's fair to admonish someone for using the colloquial norm. The comment might read better if stated less as "careful, you're doing something wrong" and more in the tone of "here is another viewpoint you may find helpful and interesting."

To add to your comment, I wish that high-functioning ASD people would stop ignoring the more severe end of the spectrum. If you are high-functioning, then maybe ASD just makes you quirky and different. But for the lower functioning people, ASD can profoundly affect their lives in extremely negative ways. For example, my son almost starved himself to death because of sensory difficulties. He is four years old and still cannot feed himself. For my son, ASD is not just a small difference that the world has not accepted yet. It's something that possibly could have killed him if he had had less devoted parents and/or lived in less privileged circumstances.

And my son is not even a particularly extreme case. With lots of therapy and a little luck, he may be considered high-functioning someday. Other kids might be in diapers forever, never talk, and live in a group home their entire adult lives.

So I struggle to take seriously the high-functioning people who throw fits about what language we use to describe our situation. I've had people get mad at me for saying that I have a son with autism when I apparently should have said that I have an autistic son. I'm sorry, I'm too busy keeping my son alive to care!

Absolutely. One of the biggest problems in autism advocacy is high-functioning people (like me) and (the guardians of) low-functioning people constantly talking past each other. Some people are perfectly happy as they are and don't want to be changed, some people are desperately unhappy and could really benefit from treatment or even a "cure". The spectrum is far too broad for a single approach to work.

> I've had people get mad at me for saying that I have a son with autism when I apparently should have said that I have an autistic son.

I honestly can't remember which one of those I'm "supposed" to be. I could make a case against either: "person with autism" might sound like it's some outside affliction, "autistic person" might sound like the condition matters more than the person. But extreme concern over small details is a defining trait of autism, and I do it too on other subjects, so I suppose I can't be too judgmental...

I think the trend these days is to use People-first language: https://en.wikipedia.org/wiki/People-first_language (that is, saying "person with autism" - because it puts the person first)

> People-first language ... is a type of linguistic prescription to avoid marginalization or dehumanization ... when discussing people with a health issue or disability.

The argument for "autistic person" or even "autist" is that it's not a health issue or disability.

That's the error I was addressing in my earlier post. For me, autism is not a disability. For someone like BadCookie's son, it definitely is. I personally don't care either way about "person with autism" vs. "autistic person", but it's dangerous to assume that autism is never a disability because high-functioning people exist.

> I've had people get mad at me for saying that I have a son with autism when I apparently should have said that I have an autistic son.

It has become exhausting trying walk the ever shifting minefield of acceptable verbiage. I'm not sure how you would apply this to other situations. If you have a son with red hair should he be called your red headed son? That sounds more offensive right?

If it's not affecting you in a negative way then it's not a disorder. If it is then it can be. If it doesn't have serious negative impacts then you're just non-neurotypical which is fine. People have the same opinions around ADHD but when you need accommodation or treatment it's worth classifying it as something that needs some level of accommodation or treatment.

"Normal" people get all sorts of accommodations and treatments - the world is set up to support their needs. People with different needs, who need different accommodations are then labeled as having a "disorder". It's a biased system which doesn't allow for normal variations between types of people.

And other people suffer from an inability to engage and thrive in the world. If you don't have a disorder, that's great. Some do.

Doesn't that reasoning apply to any disorder? Medically, a disorder is simply "a disruption of normal physical or mental functions." So, having any disorder makes one abnormal, unique, special, and possibly above average or below average, but certainly not average.

"Disorder" and "special physiological difference" are synonyms.

“Disorder” is explicitly pejorative.

I’m not sure where I stand wrt the position that autism is just a non-inferior neurovariant, but let’s not pretend we don’t understand the difference between asserting it’s a value-neutral variant and a disease.

No, "disorder" is explicitly clinical. The words "retarded", "dumb", and "stupid" are pejorative.

Calling autism a disorder is an accurate paychiatric description, not a value judgement designed to insult a person's identity. An insult can be targeted at a person's autism, but not simply by describing it according to clinical terminology.

I sympathize with people who don't believe autism should be considered a disorder, but that doesn't mean discussion needs to be encumbered by walking on eggshells. In particular, admonishing someone for using established clinical terminology is unproductive.

"retarded" and "dumb" are also clinical terms. They only stopped being clinical terms because people attached connotations.

https://en.wiktionary.org/wiki/euphemism_treadmill

Yes this happens over time as clinical terms are used in a derogatory manner over a period of several decades. This will always happen and some clinical terms will continually need to be revised over time. It doesn't mean that "disorder" isn't appropriate in 2018. It just means it may not be appropriate in 2058.

Alright, if you'd like me to excessively specify my point: "retarded" and "dumb" are adjectives not used in the DSM 5, which means they are not modern clinical terms. They have also been abolished completely. "Disorder" is still in common use, not only for autism but across the DSM as a common term meaning "atypical and diagnosable." So yes, "disorder" is an appropriate term at the moment. Whether it will continue to be in the future is irrelevant for present conversation.

For what it's worth, if you're arguing that "disorder" should not be used on the basis of precedents like "dumb" and "retarded", the page you cited is an exceptionally poor reference. The quotes appear to be mocking this phenomenon.

> "Disorder" is still in common use, not only for autism but across the DSM as a common term meaning "atypical and diagnosable." So yes, "disorder" is an appropriate term at the moment.

In a clinical context, yes. But there are probably close to zero clinicians in this thread.

One problem with the term "disorder" here is that quite often, it's applied to someone who has difficulty thriving under the many accommodations given to neurotypical people. If the autism spectrum was the norm, neurotypicals would have a similar disorder.

> Whether it will continue to be in the future is irrelevant for present conversation.

Not necessarily. It's perfectly possible for society to lead clinicians on issues like this, which is what seems to have happened with words like "society" and "dumb".

Is that the psychiatric definition of disorder?

My understanding is that it has to be disagreeable to the person who has it or put others at risk (in extreme instances).

So for example, someone with synesthesia might be considered disordered only if it prevents them from being happy or taking care of themselves, while many people with synesthesia seem to enjoy it.

A clinically important syndrome; that is, it's a collection of symptoms (these can be behavioral or psychological) that causes the person disability or distress in social, personal, or occupational functioning.

Disorder is deviation from a declared healthy norm. "Difference" is more symmetric.

A disorder is a condition that causes suffering.

But that suffering may be the result of attempting to function in a system set up for a different type of person. "Disorder" is, in many cases, a biased way to look at it.

I have family diagnosed with ASD (all high-functioning). They're obviously different and abnormal, and they know it. In fact that specific knowledge that they're abnormal is a source of anxiety in individuals with ASD. I think it's perfectly reasonable to call it a disorder, and they seem fine with it also.

Be careful about that kind of wording. Those of us with loved ones who have severe autism consider it a "mental disorder" and not simply a psychological difference. We'd really love for all of the "neurodivergent" people to have their own diagnosis.

Thanks, but I care more about what a person with autism says than somebody who simply knows one.

Many people with autism don't have enough communication skills to do that.

You are correct because your statement doesn't quantify it in any meaningful way, which is the least useful kind of correct. For example, I can also say that "many people with autism do have enough communication skills to do that". We both understand how a lot of readers will interpret these two statements if made in isolation, even though that is wrong. They can both be true at the same time (and in this case I'd say they are), which is why it's not a useful statement to make. They appear to contradict, but don't actually do so because they don't claim anything of value.

You can learn more about certain people with autism by talking to people who care for them than by talking to them, especially online. That's all there is to my statement.

I'll try to get my little brother to sign up to a hacker news account. If we get that far without me doing it for him, we'll see if you can make sense of his response.

He doesn't have a great ability to write because he's severely autistic. You know, the disorder kind that makes it difficult to learn to read and write?

> I and friends who're on the spectrum don't consider it a "mental disorder".

If you lack the capability to simulate the mental state of another human being based on observation, you're deficient in a key aspect of what we consider to be a normal functioning mind.

This is not a judgement on your character! Don't confuse the two. We don't think people with Down's or any other disorder are bad, or unworthy of a good life and plenty of opportunities to succeed.

But it is a disorder, especially for those who are much more profoundly impacted than yourself, and if it can be addressed with treatment or prevented entirely during pregnancy, it should be.

My sister is on the spectrum, and she agrees with the idea that autism is a mental disorder. What she disagrees with is calling anyone on the spectrum "disordered". So she'd agree with you that most autistic people shouldn't be labeled that way, but disagree that no autistic people should be.

Even at her low end of the spectrum, it can cause a lot of distress and pain. I guess it just depends on a person's particular case and the circumstances of their life.

I hear you but the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) classifies it as a mental disorder.

Autism Spectrum Disorder 299.00 (F84.0)

I wouldn't use this as a supporting argument. Didn't DSM-3 classify homosexuality as a disorder?

Really? A widely recognized reference manual is blanket discredited because it made a mistake in the past (1952-1974, not DSM-3)?

That makes it a book in which some statements are social reflections rather than statements rooted in good science, which makes other such statements somewhat suspect.

It doesn't mean you should reject the whole thing out of hand but it might be a good idea to try to figure out how much of it is todays bias rather than good science in cases where that is warranted.

I'd contend that the most useful ground state for most of us, being people with no knowledge in the field whatsoever, is to assume that the DSM is broadly correct. From there you can, given some evidence, conclude that parts might not be.

I'm not sure, but I bet you're right. It is a medical reference that will change over time as better information becomes available. It's still the definitive manual for classifying mental and personality disorders.

That's political. Of course it's a disorder in the sense that it causes abnormal poor performance (reproduction is harder!). Peadophilia is also still called a disorder but only if it negatively affects the person's life. It hardly matters how we classify them. Everyone has some inferiority that they might want to improve, so we could all say we have disorders. Or we could all accept everyone as just-how-they-are.

DSM-5 also forgoes Asperger's and just includes it into autism now, which a _lot_ of people with either diagnosis tend to disagree with. There are many different ways autism and its variations present, and trying to "homogenize" them all into a single narrow label masks the complex nature of the condition (IMO).

There seems to be a ton of debate on lumping and splitting various disorders in the DSM. If I remember correctly academics like to split, practicing clinicians like to lump. There is so much overlap in many conditions that psychologists and psychiatrists that actually deal directly with patients question the need to split every small permutation of symptoms into a distinct disorder. I'm not saying the DSM-5 is absolutely free of issues as I'm sure DSM-6,7,8,20 will be an improvement.

Essentially all psychological differences vary from a behavioral quirk to a disabling disorder. The distinguishing line between psychological difference and psychological disorder can (probably) vary from person to person: the only valid distinction is if the psychological difference causes problems for the person.

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