It’s often been suggested that I am on the autistic spectrum, probably more Asperger’s than “classic” autism. I don’t agree with this assertion for a variety of reasons, but as well as getting into that I want to talk today about various issues surrounding this.
The only official diagnoses I have are ADHD, which I discuss here, and gender incongruence, which I’ve been into in great depth on another blog devoted to this issue. I see both of these as forms of neurodiversity, and in fact I believe that this entire household of four people is entirely neurodiverse. But there’s also the issue of self-diagnosis, which has a number of issues associated with it. On a somewhat different issue, I would be extremely surprised if I wasn’t diagnosable as depressive, but I’ve never pursued this. In fact I’d be so surprised if I couldn’t get that diagnosis that I’d probably end up doubting the competence of the people who hadn’t diagnosed me rather than the fact that that fits. The classic questionnaire for that, used for self-diagnosis but officially approved, whose name currently escapes me, shows me as having mixed generalised anxiety disorder and depression. I simply do not care about those labels: if the world was a less depressing and worrying place, I’d be fine, so that’s how to address that in my case. This isn’t supposed to be dismissive of anyone else’s conditions. I also have a strong family history of diagnosed depression which I won’t go into for confidentiality reasons. I should also point out that whereas I have self-diagnosed in this case, I am actually an experienced clinician although the objectivity goes out of the window when your patient is yourself.
But the case for me being Aspie is different. On going through the process of diagnosis for gender incongruence, then known as gender identity disorder, this did touch on being on the autistic spectrum and there is considerable “comorbidity” there in that sixteen percent of people who are gender dysphoric are also probably on the spectrum as opposed to 0.03% in the general population. However, it needs to be born in mind that ideally, most diagnoses should be to the advantage of the patient, and for me being diagnosed as this would drastically increase my gender dysphoria. I need to make something clear before I go on. When I look at the way people on the spectrum behave and think, it strikes me as “normal”, in the sense that I can often empathise with them. Neurotypical behaviour often comes across to me as if the people exhibiting it know some kind of secret the rest of us haven’t been party to and I often find it baffling. It’s like they’ve got a rule book which wasn’t given to me. Hence it could be said that my first impulse in behaviour is often to do things in such a way as to be labelled as autistic. In a way, autism is my “normal”.
Simon Baron-Cohen is well-known as the successful promoter of the “extreme male brain” theory of autism. That is, he sees being on the spectrum as resulting from a greater response of the central nervous system to the action of androgens. It’s often said that “I am my brain”, and I have some sympathy with that except that in fact I think identity is probably either larger or smaller than the brain rather than the exact size. I am, for example, not my basal ganglia because if I had Parkinson’s I imagine it would feel like an obstacle to me and not something I did naturally, and if someone is brain-dead it’s still the role of their next of kin to give permission to turn off their mother’s life support. In such cases, people obviously can’t be their brains because their brains are hardly functioning at all. And they usually aren’t functioning at their funerals either. Even so, there’s a lot of truth in the idea that I am my brain, and if Baron-Cohen’s theory is correct and I’m on the spectrum, that would make me extremely male. The only reason this thought wouldn’t make me suicidal is self-hatred – I would want to continue living as a punishment to myself. Someone who thinks more straightforwardly probably would consider killing themselves to be the appropriate response at this revelation. Therefore it really wouldn’t be good to get a diagnosis of Asperger’s for me. I find it, incidentally, very strange indeed that other trans women don’t find the idea of being on the spectrum absolutely devastating.
Of course it is also true that Asperger’s is underdiagnosed in women and tends to manifest itself differently because of their different social roles. Incidentally, I’m referring to Asperger’s here out of convenience and recognise the problematic nature of the name and the idea that it’s a useful concept as opposed to the rest of the spectrum. A major difference between the presentation of the “syndrome” in women is that they tend to mask more effectively, or at least are called on by social pressure to do so, than men. Masking is the inauthentic performance of neurotypical behaviour, and the patriarchy coerces women to do this far more strongly than it does men. It can become a habit, but it tends to be very tiring and lead to withdrawal and acting out in apparently safer circumstances. For most people it would be better if this pressure wasn’t exerted. Since it’s a vital survival strategy for women to have to do this, the learning curve is very steep and has to be traversed as an urgent necessity, and it’s claimed that this leads to them being underdiagnosed. This is not my experience as a trans woman because the social role carved out for me is masculine, and probably at least as baffling and hard to fit as not being “autistic” is. Therefore that long list of criteria which you may be familiar with about how women Aspies are not like men doesn’t apply to me, just as, presumably, it doesn’t apply to any other trans women unless they transitioned really young.
But I can certainly get on board with the idea that Aspergers is literal testosterone poisoning and that it stops my brain doing what it’s supposed to do. I would like to know more about the research supporting Baron-Cohen’s theory but I avoid finding it out because I fear it will be triggering, so I’m going to move on in my ignorance to touch another issue.
I said before that I am not a textbook case of an Asperger’s person. If I do a questionnaire on the issue, it tends to show that in certain aspects I am indeed strongly typical of an Aspie, but there are always a large number of other answers which show me as the opposite of that. This online test shows me as having “many tendencies of an autism spectrum disorder”, and yes, I know it’s not a good idea to set too much store in such things, but I’m also perceived as being very polite and diplomatic, I choose not to speak in groups rather than avoid it because I think I talk too much and I don’t like the sexual politics of formerly male-assigned people talking more than cis women, I make a point of varying daily tasks out of habit, my ADHD probably contributes to poor planning and I find it hard to imagine fictional characters visually but that’s probably to do with prosopagnosia and I don’t know if that correlates with being on the spectrum or not. I recognise people from context, clothing style and hair rather than faces. This, I think, confirms what I said before: that although I have Aspie tendencies I am probably better described as “neurodiversity not otherwise specified”, if that exists as a diagnosis.
Religiously I also have a number of issues with the very concept of autism. The dominant theory of autism is that it involves the absence of a theory of mind, i.e. impaired ability to empathise. This is deeply problematic from a traditional Christian perspective because it seems to entail that autistic people are incapable of sin, which is essentially selfishness in my view, and if the idea that “all have sinned and fallen short of the glory of God” is correct, it has to mean either that autistic people do have a theory of mind and can empathise and therefore do commit sin, or are capable of doing so, or that sin is something other than selfishness. Now I accept evolution of course as well as a lot of other things which some Christians question or reject, but on this occasion I have allowed my religious beliefs to interfere with my perception of a scientific perspective. Another feature of autism is that there is no filter to input or output, as it were. That is, we (assuming I am Aspie) are unable to filter out distracting sensory stimuli as well as being unable to, for instance, “blurt things out” which are seen as inappropriate. The input side of things could be particularly relevant here as there is also a salience theory of autism, or rather, the “salience network” dysfunction hypothesis of autism. It amounts to this. There is a whole blizzard of sensory impressions presented to the brain, something Kant called the Manifold (actually he presumably didn’t call it that but I don’t know what German word he used). Now imagine trying to spot something like eye contact or a tone of voice out of all that stuff. I think the result of this is that one doesn’t get the opportunity to develop social skills, and it then becomes harder to do so as one matures and the brain becomes more hard-wired – one gets “stuck in one’s ways”. Although this opinion has been foisted upon me because of the fact that I’m Christian, I do think it has its merits.
Another view of the failure of empathy in autism is that it results from the very neurodiversity of our (is it our) brains. When a neurotypical person puts themselves in the position of another, they stand a better chance of anticipating their thoughts, feelings or behaviour because they’re effectively attempting to simulate the inputs and outputs of a brain similar to them. If the person attempting this is on the spectrum, they are imagining an atypical brain in that situation and unless the person concerned is themself on the spectrum, they’re less likely to be able to predict what’s happening for them. Hence it isn’t so much a simple failure of empathy as the inability to understand how someone else’s brain works. Note also that if you turn this round and imagine a neurotypical person putting themself in the position of someone with Aspie, and failing, for example, to recognise clothing sensitivity or aversion to persistent loud noises, this is a similar failure or empathy. It’s just that there are fewer of “us” than there are of “them”.
Lack of a filter has also been evoked to explain apparent failure of empathy in another way. It’s easy to become overwhelmed by sensory inputs as someone on the spectrum and this can lead to shutting down. Bearing in mind that like other diagnoses neurodiversity frequently doesn’t fit into a neat box, ADHD people can also be overwhelmed by stimuli. Therefore they have a coping mechanism, which may not actually be coping by the way so much as descending into a kind of breakdown, of shutting down and not perceptibly responding. If a particular feeling or situation is overwhelming to them, including the impression of emotion, the very fact that they can empathise might lead to this kind of shutdown, and it then looks to a bystander that they’re not responding. The fact is that they may be responding only too strongly.
I’m not an expert on the autistic spectrum by any means, and I’ve already warned about the inappropriateness of self-diagnosis. Nevertheless, I hope I’ve managed to express my perspectives on this issue. I’m also aware that what I’ve said may be controversial. If so, please feel free to put me right in the comments.
A Box Of Chocolates 