Interview by Philip Wylie
Date: 24 October 2013
Q1: What are the chances of an undiagnosed Aspie being successful (without self-knowledge of his or her neurological condition)?
The odds are stacked against them (undiagnosed aspies) because they may make unwise decisions made on the basis of their strengths rather than weaknesses or what other people expect. If they have been successful, it has been through a supportive relationship partner who gives them the moral and emotional support, guidance and confidence they needed.
Another related question is how can Aspies cope with the ignorance and prejudice of other people towards people who are different? Some people are kind and supportive, whereas others can become predatory – so the problem is not limited to coping with Asperger’s; the greater problem is coping with other people. People with AS don’t suffer from their neurological condition, but they do suffer from the attitude and ignorance of other people. In my clinic I refer to ‘the Psychology of Predators’. The person with Asperger’s cannot have closure of their concerns until they understand why they are victimized, passed over for jobs, failing job interviews and not being successful in their relationships. I explain the psychology and motivation of other people otherwise there tends to be either negative self-evaluation or anger towards the thoughts and actions of other people. Both ways are not constructive ways of dealing with the situation. Aspies can defuse the anger through accessing knowledge and appropriate information. I describe Asperger’s as a different culture, so Aspies need a translator between the two different cultures. It’s not so easy for people with Asperger’s to avoid the predators because they are literally everywhere, whether in the office or at the church, so it’s almost impossible to avoid them. The predators have an ability to identify relatively vulnerable targets.
Q2: Is AS or autism inherited genetically?
Half of the AS population inherited their condition genetically and it’s possible to see a family line of autism. Secondly, it may involve genetic material, but not inherited. For example, Downs syndrome is caused by genetic material that is not inherited. Then there is another group for which genes are not the cause, but something in utero or early childhood affected the child’s brain. These three pathways need to be recognized.
Q3: If AS is inherited genetically, wouldn’t diagnosis be facilitated by investigation of the family’s ancestry?
This is useful information for parents of ASD children who want to know about the likelihood of having another ASD child. This is what geneticists call ‘penetration of the family line’. If the genetic markers are identified, my concern is a eugenics approach of cleansing racial purity by getting rid of potential geniuses of the future. Most of the people who made major advances in art and science have Aspergic characteristics. To be successful as a species we need neurodiversity. If we use an analogy with Star Trek, we need Balkans.
Q4: Why don’t we use genetic testing to diagnose Asperger’s?
Simply because we don’t know what are the genetic markers. Research is underway, but it will probably be multiple genetic markers. We may however be able to identify the risk of ASD in young children during their first two years of infancy but doubtful in utero.
At some stage during the primary school years, the child will realize he or she is different. The questions is how the childpsychologically reacts to their perceived differences. In my book, The Complete Guide to Asperger’s, I refer to the internalizers of depression and escape into imagination, or the externalizers who have inflated self-esteem and arrogance, or those who imitate and ‘fake it’. Depression and anger are not recommended. So it’s really to prevent secondary mood disorders and personality disorders. Sometimes it’s the pathway of a personality disorder that leads to the diagnosis of Asperger’s syndrome. The main personality disorders caused are Borderline personality disorder (especially for women), Narcissistic personality disorder, Schizoid personality disorder and other disorders like Pathological Demand Avoidance disorder. How the person sees themselves will determine in part what their pathology will be if they are not give appropriate support and true understanding. A Borderliner is someone who feels a sense of betrayal in relationships when friends move on, intense emotions and intense despair. Quite a few late diagnosed females who have Asperger’s were diagnosed previously as having Borderline Personality Disorder. Narcissistic Personality Disorder (NPD) occurs more in males who have an over-compensatory sense of arrogance. So depression is low self-esteem, whereas NPD is inflated self-esteem. The imitation group (who wear a mask and pretend to be normal) tend to have Multiple Personality Disorder.
People with Asperger’s either see themselves as being defective or superior. It’s very comforting to think of oneself as superior, especially if you have a talent in mathematics, science or art.
Q5: If an infant has attachment difficulties with his / her mother, is this a red flag for autism?
We look to see whether the mother is giving appropriate signals of bonding, interaction and affection. But the child may be reading these signals or find contact aversive due sensory sensitivity. So with Reactive Attachment Disorder we have a parent who creates within the child the isolation and psychological problem due to parenting issues. Here it’s more a matter of the infant reading and understanding the interpersonal signals but also finding touch aversive. Sometimes affection is given in the form of touch which the person finds aversive. That’s what happened with Temple Grandin. She craved affection but when her mother touched her, it was most uncomfortable. That was tactile sensitivity, not an aversion to her mother at all.
The mother senses very early on that her child is different and then makes various accommodations. The differences can be spotted during very early childhood if you look carefully. But you have to know what to look for.
Q6: What are the probable consequences of very late diagnosis of Asperger’s syndrome?
Psychopathology, depression, issues of legal and illegal drugs to self-medicate, stress, anxiety disorders, also medical disorders that are due to stress (such as gastrointestinal problems, headaches and exhaustion), issues relating to career choices and success, and relationship issues. There can also be issues of anger management because you either internalize it and blame yourself causing an implosion, or explode with anger towards others for being illogical or inconsistent. The risk for individuals with such high levels of anxiety and being aware of their social confusion is to reduce anxiety and create a bubble of security and safety through use of alcohol and marijuana. Initially these drugs serve as medication for anxiety but also as a relaxant in social situations (or to be ‘comfortably numb’). This combination of self-medication can be dangerous for people with Asperger’s because in order to cope they need to use their frontal lobe. The frontal lobe is dissolved (deactivated) by alcohol and marijuana. Therefore the part of the brain that is needed for social reasoning is deactivated after using these substances, so their coping mechanism has been removed.
The value of anti-depressants lies in its quality and being less dangerous because intoxication does not occur. The person needs help with emotional management. I would prefer that patients use prescribed drugs rather than misuse legal or illegal drugs. I also advocate psychological support for dealing with emotions.
Q7. What are the likely consequences of not providing adequate support to an autistic child?
What a terrible waste of talent! He or she would lead a life of misery when they could have a good and productive life. We need the Aspies!
Q8. Can mental ill-health be prevented by appropriate and timely intervention during childhood?
Yes. There would be less chance of developing clinical depression, being bullied, alcohol and drug use. One of my great concerns is that the psychiatric services for adults really do not understand Asperger’s syndrome. They need the training as well as the attitude shift and it is rare for a person with Asperger’s to actually benefit from admission to a psychiatric unit. I have never actually encountered a single autistic person who benefited from admission to a psych hospital (and I have been working in this field since the 1970s). Psychiatric units have an adverse affect on people who have Asperger’s because the staff don’t know about AS and they may not understand that Aspies don’t work well in groups. Thirdly, the person is in the company of other people who are emotionally challenging, volatile and extreme, which is very upsetting for the person with Asperger’s. What they are seeing is an asylum in the old sense of the word, and a lunatic asylum is not relaxing. If you are in one, it’s full of people with intense emotions and interpersonal difficulties, and the person with Asperger’s does not know intuitively the ground rules of this new culture. So they feel like they are on another planet: Planet Psychiatric Hospital. I do everything I can to keep people with Asperger’s OUT of psychiatric hospitals.
Q9: Is it fair to judge an Aspie’s behaviour if he is experiencing a mental breakdown or involuntary meltdown?
Neurotypicals have never experienced Asperger’s so their attitude is ‘Pull yourself together!’ or ‘Calm down!’ without realizing that it’s not going to work.
For many years the Aspie has experienced intense emotions and when they receive the diagnosis there is a paradigm shift and a complete re-evaluation of self. The trauma of this paradigm shift affects people in different ways. Some are relieved, others are traumatised if they feel uncertain about the future because most people with Asperger’s find it difficult to adjust to change. However there can be a sense of euphoria after realising that we are not psychotic or mad. But it brings all the emotions to the fore of ‘why do I have to deal with this so late in my life?’ This should have been identified by professionals in the past. How will my life change because now I have to explain myself to people who don’t seem to understand my problems?
People with AS are not good at describing our inner thoughts and feelings to others. Often this means that emotions are swirling around in our mind but we have difficulty grasping them, defining them, and disclosing them to others. Self-reflection. So the person is going through all sorts of changes so they need lots of support. After diagnosis the person needs counselling to come to terms with his or her revised self-image, but often diagnosticians don’t offer such services.
Q10: Can very late diagnosis of AS cause a mental breakdown or traumatic crisis?
Yes. Their whole concept of self and explanation for past experiences – the scaffolding that kept them going – has now gone. It’s a huge paradigm shift with an alternative that they have yet to discover and use constructively. There is a mind-body division – a difficulty of the brain connecting to the physical body – and this will be eventuated during this crisis, so the person is likely to be in a very psychologically confused state, needing support and understanding, which is often not available. The diagnostician should explain why the person was bullied and confused in the past, as well as explaining how their gifts can help them for the future. However, many clinicians in the UK lack the necessary knowledge; they may know how to perform the diagnosis but they don’t understand the Aspie mind.
Q11: In your experience, is at least one of the Aspie’s parents unable to love or be empathetic?
There are three forms of empathy:
- Cognitive empathy (lacked by people with AS)
- Emotional response to the despair of others (people with AS have a lot of this)
- Reaction (not knowing how to respond, fear of failure, confusion)
Like to Love is a new book by Tony Attwood (JKP) about affection.
There is a breakdown in communication of affection. The child may be overwhelmed about affection. Some mothers overcompensate and give more affection, but this strategy does not work. More overwhelming for the child.
Tony is trying to promote psychotherapy for Aspies by Aspies.A new model specifically for Aspies.
Tony Attwood’s website address is www.tonyattwood.com.au.