Comment by skissane | Hacker News Reader

Comment by skissane | Hacker News Reader

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> Autistic adults have significantly low blood serum levels of AEA. Autistic people’s neurons prune slower. Schizophrenic people’s neurons prune faster.

These are all group-level findings, meaning they aren't true for every individual. You can do a study and find that there is a statistically significant difference in mean X between two samples – autistic vs control or schizophrenic vs control. But pretty much always, although there is a statistically significant difference in the mean, the two samples overlap – which is consistent with this being a factor which only explains some of the cases.

> It seems the ECS system is the principal driving mechanism behind both conditions.

Claims like that ("the principal driving mechanism behind psychiatric diagnosis X is biological difference Y") have been made many times before, and few of them have gone anywhere. I'd be surprised if this one turns out differently.

Both autism and schizophrenia are bundles of different conditions which we've grouped together on the basis of nothing more than overlapping systems. Two people can both have "autism", yet at a biological level they've got two completely different things. The same applies for two people with "schizophrenia". This is why a number of researchers have been arguing that diagnosis-centric research is a dead-end.

I wouldn't be surprised if ECS system issues (or any other system in the brain) turn out to be the cause of some cases of autism and some cases of schizophrenia; but there will be other cases of both in which it isn't the "principal driving mechanism" at all.

You know whats really interesting? Autism and Schizophrenia used to refer to the same condition. The term "autism" was invented by Bleuler, who worked with Freud, as a shortened version of his "autoerotism" and referred to a state where a patient was totally absorbed in their own fantasies to the point of hallucinating them. This becomes clear if you look at Jung's "introvert/extrovert" dichotomy (Jung, who worked in Bleuler's lab!), where someone extremely introverted could be BOTH autistic--not communicating with others--and schizophrenic--absorbed in their own fantasies, not concerned with the real world.

Now, clearly, mainstream psychology disassociated these terms sometime in the 60s, when the goal with autism diagnoses was moreso to find and identify "abnormal" children (Hans Asperger famously used Autism diagnoses to euthanize children, that's who "Asperger's Syndrome" is named after!), and Schizophrenia gained its own separate classification. But its interesting to note that there was a time when social disaffection in general was considered a single set of disorders.

> (Hans Asperger famously used Autism diagnoses to euthanize children, that's who "Asperger's Syndrome" is named after!)

Asperger was assigned to identify autistic children for exterminatiom, but mafe the case that certain ones were useful to the Reich, which is why “Asperger’s Syndrome” became the name for the manifestation of autism that was seen as a leader impairmemt.

He wasn't assigned to identify "autistic children" specifically for extermination. Hans Asperger was a psychiatrist. Psychiatrists in Nazi Germany (post-Anschluss Austria in his case) were expected to evaluate all of their patients for potential extermination, children included. Some psychiatrists refused to cooperate with the regime, at great personal cost to themselves. Other psychiatrists signed up to become enthusiastic members of the Nazi Party. Asperger chose a middle path – he chose not to join the NSDAP, but he joined some of their affiliated organisations; he chose to cooperate with the regime, and be supportive of it–not in an overly enthusiastic way, but with sufficient enthusiasm to ensure his Nazi superiors would not stand in the way of his career advancement.

He did successfully argue that some more intelligent children should be spared, on the grounds they had unique skills which could be valuable to the regime. However, less intelligent children, he was happy to refer to be murdered (in most cases without the knowledge or consent of their parents). He wasn't evil in the way in which many devout Nazis were, just in the more banal way of the many who collaborated in the regime's crimes out of personal self-interest, or through coming to believe its propaganda.

That sounds like "just following orders" with extra steps.

I'm certainly not trying to defend the guy. If anything, I think a lot of people in the "autism community" want to defend him (even if only to a degree), in part because they feel some emotional attachment to the label of "Asperger's" and are trying to shoot down the argument "we shouldn't use that label because it is named after a Nazi collaborator"

For all of Asperger's sins, he was too humble to actually name a disorder after himself – he called his disorder "autistic psychopathy". Lorna Wing renamed it after him, because the word "psychopath" had become very stigmatised, and Asperger was using it in an older and broader sense than current discussions of "psychopathy", which is prone to confuse the uneducated layperson. Wing was actually one of the people trying to defend Asperger–before her death, she wasn't aware of the further historical research published on this topic after she died, and who knows whether she would have revised her position if she'd lived to see that–it is understandable she'd want to defend one of the major decisions of her career–and she was (at best) dimly aware of this aspect of Asperger's history when she made that decision

I will admit to myself sometimes using "Aspergian" in describing some of my own personality traits, not because I necessarily agree with the term, but simply because it is a useful shorthand which my listener is likely to understand, and as much as I'd love to dump all these details and more on them, it risks overwhelming their time, attention and comprehension

I myself am of two minds about it. On the one hand, I'm very appreciative of shows like Extraordinary Attorney Woo and the contemporary diagnostic criteria which does seem to assist many people who otherwise wouldn't get very far in this world. There is definitely some sort of disorder called "autism," and you know it when you see it.

On the other hand, Autism Spectrum Disorder basically doesn't exist, it was designed specifically to cover as many possible definitions of Autism such that nearly anyone, under the right circumstances, could be labeled as Autistic and be given expensive treatment, and I think there is something dangerous in people self-identifying with this label as it only feeds into the larger psychiatry-industrial complex. It's similar to depression--some people legit can't get out of bed in the morning, but the drugs we use to treat it are handed out like candy, are not approved to be used for the terms that they are, and don't even perform better than a placebo.

The problem isn't that some people are "neurodivergent" and others aren't, and neurodivergent people shouldn't be ashamed and should embrace their label. The problem is that everyone is neurodivergent--everyone is "perverse," as Freud famously elucidates in his theory--its just that those who are labeled as "other" under the system get exploited, and everyone else, for fear of the same fate, hide all their psychological proclivities from everyone except from their most intimate acquaintances. And there are some who are lucky enough to avoid both fates, but they are rare among the ruling class, and the commonality of ostensible abnormal psychology among the working class is considered a "problem" to be solved by endless mental health facilities, treatment programs, etc. meanwhile the real pains of being a working class American forces many into addiction, and what they are offered can do nothing much to alleviate the underlying problems which led them there (often times problems, as in the case of the opioid crisis, generated by the very corporate structure which also drives people to treatment for their addiction).

I learned about all what you discuss because I wanted to find a genealogy of "Autism" as a why of critiquing it as a medical category. But I don't know, as I said there is definitely some constellation of symptoms and ways of treating them that would fall under an Autism diagnoses, its just that how such a diagnoses came to exist was not through some pure empirical scientific process but a historical, social process that can't be disassociated from the other socio-economic realities.

I see some overlap between what you are saying and the viewpoint of Laurent Mottron, see https://onlinelibrary.wiley.com/doi/10.1002/aur.2494

He criticises the "autism spectrum" saying that it "is a convention that changes over time and belongs more to the history of science than neurobiology" (a rather scathing remark but put it in an understated way)

On the other hand, he insists that "prototypical autism" should be retained as a real target of scientific investigation, and he proposes that our failure to discover its causes (despite immense research funding into the project) is largely due to going astray by broadening its definition (through the "autism spectrum") to the point that it is approaching meaninglessness

For a different viewpoint, see Lynn Waterhouse et al – https://link.springer.com/article/10.1007/s40489-016-0085-x – who argue the whole category of "autism" (whether a broad "autism spectrum" or a narrow "prototypical autism") is a dead-end, and researchers ought to abandon it and look for new concepts to replace it with. In her book, she proposes (as a temporary measure) replacing "autism" with phenotypes of neurodevelopmental social impairment – which unlike "autism"/"ASD", are only defined in terms of deficits in the social communication domain, but allows those deficits to coexist with deficits in other domains (repetitive behaviours, restricted interests, impulsivity, attention deficits, dyspraxia, dyslexia, epilepsy, intellectual disability, etc)

And then there's Sami Timimi et al's book "The Myth of Autism" which, as well as criticising the science of "autism" (as Waterhouse and, to a lesser degree, Mottron do), goes beyond that to criticising it as a cultural construct, arguing that the harm it causes outweighs its benefits

> The problem isn't that some people are "neurodivergent" and others aren't, and neurodivergent people shouldn't be ashamed and should embrace their label. The problem is that everyone is neurodivergent

To quote Timimi, "We are all (humanity) simply neurodiverse" – https://www.madinamerica.com/2018/04/the-scientism-of-autism...

> This is why a number of researchers have been arguing that diagnosis-centric research is a dead-end.

Just sounds like they've been diagnosing by symptom because they didn't know the actual etiology. Once it's known shouldn't they just change the diagnosis to be the new, more specific condition? Seems like diagnosis is still the goal?

> Just sounds like they've been diagnosing by symptom because they didn't know the actual etiology. Once it's known shouldn't they just change the diagnosis to be the new, more specific condition? Seems like diagnosis is still the goal?

Well, we don't know the aetiology (in most cases), so while restructuring diagnosis on the basis of aetiology is defensible as a long-term goal, we are nowhere being able to achieve that yet. The argument is, designing research around the current symptom-focused diagnostic categories is blocking progress in research. Two people with the same diagnostic label may have completely different aetiologies, two people with the same aetiology may have completely different labels, two people with the same aetiology one of them may have a label and the other may have none – the same underlying brain dysfunction may manifest with very different symptoms in different individuals, depending on its interaction with other biological factors, and their social environment. If we want to understand "what's really going on", it can be better to put everyone in the same sample (both diagnosed with various diagnoses and undiagnosed), then look for patterns in that big sample. I think this paper is a great example of doing that, with the help of machine learning – https://www.nature.com/articles/s41398-019-0631-2 – but it needs replication.

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