Is Asperger Syndrome a mental illness?
Is Asperger Syndrome a mental illness?
That depends on how you define "mental illness". If you define it as "something in the DSM-IV, treated by a psychologist, with primarily mental symptoms", then yes, it's a mental illness. But consider: Under this definition, many other things are mental illnesses: Mental retardation, learning disabilities like dyslexia, ADHD, speech impediments, Alzheimer's. Putting autism in that group makes sense--even if "mental illness" has connotations that those things don't have.
On the other hand, let's define mental illness as "a condition with emotional, behavioral, and sometimes psychotic symptoms, treated by a psychologist, which causes distress and impairs function." Under that definition, none of the above (including autism) qualify. This is the more commonly used definition of mental illness...
You know, reading the above paragraph, I realize I have trouble properly explaining the average-person idea of "mental illness"; my definitions don't really seem to draw a mental line between the two groups. All I really have is a large list of examples which people would consider to be "mental illness" and I have trouble properly drawing out the common characteristics.
So maybe it would be better to just make a list of what most people would consider to be "mental illness".
I went through literally all of the DSM-IV categories to pick those out. (Wikipedia rocks, incidentally.) They made up barely a quarter of the available diagnoses. Also note that the previous list includes mostly very severe psychological disorders--the "flashy" kind they put on TV a lot--and the ones you're most likely to be hospitalized for. I actually had to debate whether to put hypochondriasis on that list, because most people wouldn't immediately associate it with "mental illness" so much as "making a fool out of yourself".
"But," some say, "Asperger's isn't a disability. If it isn't a disability, it can't be a mental illness." Hate to burst your bubble, but yes, Asperger's is a disability. That there are positive aspects to AS doesn't change that we lack some skills the world expects of us. By the social model, we are disabled, just like deaf people and wheelchair users who, just like us, simply need the right environment. Social model: A deaf person in a hearing world is quite disabled; a deaf person in a signing world is not disabled. An Aspie in a world where people use lots of vague communication is disabled; in a world where people say what they mean (and where special interests are OK and people don't create overwhelming sensory situations), he's not disabled. But of course, the social model of disability is quite another issue altogether.
The "Asperger's is not a mental illness" protest, I think, stems from this popular concept of mental illness as something that makes you "go crazy" and get put in the looney bin. This is an unfortunate state of affairs because, technically, in the medical sense, AS is a mental illness; but in the colloquial sense of the term, it's far from it.
How to explain Asperger's? Describe it as neurological--"My brain works differently". This should evoke the right connotations in the listener's mind.
That depends on how you define "mental illness". If you define it as "something in the DSM-IV, treated by a psychologist, with primarily mental symptoms", then yes, it's a mental illness. But consider: Under this definition, many other things are mental illnesses: Mental retardation, learning disabilities like dyslexia, ADHD, speech impediments, Alzheimer's. Putting autism in that group makes sense--even if "mental illness" has connotations that those things don't have.
On the other hand, let's define mental illness as "a condition with emotional, behavioral, and sometimes psychotic symptoms, treated by a psychologist, which causes distress and impairs function." Under that definition, none of the above (including autism) qualify. This is the more commonly used definition of mental illness...
You know, reading the above paragraph, I realize I have trouble properly explaining the average-person idea of "mental illness"; my definitions don't really seem to draw a mental line between the two groups. All I really have is a large list of examples which people would consider to be "mental illness" and I have trouble properly drawing out the common characteristics.
So maybe it would be better to just make a list of what most people would consider to be "mental illness".
- Various anxiety disorders: Panic attacks, GAD, OCD
- Schizophrenia and other conditions that involve psychosis
- Depression and related conditions
- Bipolar disorder and related conditions
- Hypochondria and other psychological conditions with physical symptoms ("It's all in your head")
- Dissociative identity disorder (multiple personalities)
- Eating disorders
I went through literally all of the DSM-IV categories to pick those out. (Wikipedia rocks, incidentally.) They made up barely a quarter of the available diagnoses. Also note that the previous list includes mostly very severe psychological disorders--the "flashy" kind they put on TV a lot--and the ones you're most likely to be hospitalized for. I actually had to debate whether to put hypochondriasis on that list, because most people wouldn't immediately associate it with "mental illness" so much as "making a fool out of yourself".
"But," some say, "Asperger's isn't a disability. If it isn't a disability, it can't be a mental illness." Hate to burst your bubble, but yes, Asperger's is a disability. That there are positive aspects to AS doesn't change that we lack some skills the world expects of us. By the social model, we are disabled, just like deaf people and wheelchair users who, just like us, simply need the right environment. Social model: A deaf person in a hearing world is quite disabled; a deaf person in a signing world is not disabled. An Aspie in a world where people use lots of vague communication is disabled; in a world where people say what they mean (and where special interests are OK and people don't create overwhelming sensory situations), he's not disabled. But of course, the social model of disability is quite another issue altogether.
The "Asperger's is not a mental illness" protest, I think, stems from this popular concept of mental illness as something that makes you "go crazy" and get put in the looney bin. This is an unfortunate state of affairs because, technically, in the medical sense, AS is a mental illness; but in the colloquial sense of the term, it's far from it.
How to explain Asperger's? Describe it as neurological--"My brain works differently". This should evoke the right connotations in the listener's mind.
(Anonymous)
You left some out
Sociopathic disorder
The remaining host of personality disorders
This culling exercise also leaves out the fact that for many, many years autistics were misdiagnosed very widely as child-onset schizophrenics. Likewise, there are very many cross-diagnosis symptoms between schizophrenia and the anxiety disorders and autism. Different biology, more than likely, different diagosis - very similar symptoms. Take catatonic schizophrenics, for example. That is a very similar behavior to the type of difficulty initiating muscle movement that Amanda Baggs describes. Likewise, I see repetitive movements and speech tics in autistics that are similar to those found in Tourettes. Different cause - same symptom.
What "people" think of as a mental disorder is kind of a scary idea. Most "people" are ignorant bigots, I'm afraid. I wonder about calling Aspergers or vanilla ASD a mental disorder: it's more neurological in its basis. However, I doubt that there are many people who would disagree that, based on what we currently know, schizophrenia is 100% a chemical inbalance caused either by hard-wiring reception/lack of reception of certain neurotransmitters or a problem with the chemicals themselves. So where exactly is the line?
Labels are difficult and dangerous. I am somewhat comforted by the fact that the DSM contains a bunch of stuff that ranges in severity, prognosis, and basis. At least then, when somebody cracks the DSM to try and decide how to help me or my kid, I needn't worry about the state showing up to put me away. At least not at the moment. . . .
Re: You left some out
(Anonymous)
Questions
My six year old has been diagnosed twice with Asperger's Syndrome--once by a private psychologist and again supported by the school's psychologist. My questions are, how bad is it for me to choose not to medicate him--against the advice of the psychologists--and for me to cease all visits to the psychologists?
I have pretty much decided to let my son be himself. I am going to raise him like I know how and just continue to do what I do. I've raised three other children and they are all smart and wonderful. My son is also super smart and his oddities give him his unique personality. I refuse to medicate him to make him "normal," that wouldn't be him. I like his wackiness and his humor and other than little problems here and there, he is as close to "normal" as anybody else.
I'd appreciate your feelings on my views. I just want to know if I'm doing the right thing. I want him to grow up into a compassionate adult that has a job and a nice life. I don't even care if he wants to stay home with us forever--like he says right now!
Thanks,
Joseph's mom
Re: Questions
But don't medicate just "for autism", because there's nothing that actually does anything for autism itself. Medicating wouldn't even make him normal; it would be more like making him more compliant... The only medication approved for autism is Risperdal; and that is an antipsychotic meant for children with severe aggression problems.
An autistic child grows best when he is given the education he needs to learn the skills expected of him. If he's not good at social skills, teach him how; if he's bad at handling stress, teach him how. Same as any other child... He might do things in different ways; but that doesn't really matter as long as he learns, right? And make sure that he gets lots of opportunities to use his strongest skills, because they'll end up being what gets him a job later on... Very few people are happily employed in the areas they've got weaknesses in, after all; it's the strengths that make you a valuable worker.
Congrats on your Aspie child :) You'll have a lot of stress and a lot of happiness... but then, that's parenting!
(Anonymous)
Re: Questions
"there's nothing that actually does anything for autism itself"
Maybe not yet, but if it is true that autism is reduced when the child has a fever, perhaps one day there will be a drug that does whatever it is that the fever does.
(Anonymous)
Re: Questions
I love your approach and total approval of and unconditionally loving your son. Me too! My son is 20 and I've recently come to realize after all these years that he is has Aspergers. I love him with all my heart but he does drive ME crazy from time to time.
Right now he is struggling with acceptance from the opposite sex and his heart is getting broken. It's painful to watch. He is an only child and his father and I are divorced. He has depression and refuses medication for it.
The key with these children is to not allow them to socially isolate themselves. The more they communicate and interact with other people, the more accepting of themselves they can be when they reach those critical years of adolescence.
Good luck to you. Reading your letter today really helped me.
(Anonymous)
Neurobiological is better
(Anonymous)
Re: Neurobiological is better
(Anonymous)
(Anonymous)
Their comment: I work with a guy (name) at (workplace). He has Aspergers. How can a person with Aspergers be a researcher if he does not have skills necessary for interviewing people? He is good with non living things.
My reply: We can learn those skills, just as a dyslexic person can learn to read. It takes a great deal of effort, though, so one has to choose carefully what to focus on, because learning all of them would mean ignoring one's strengths.
The person in question later contacted me and told me to remove the comment, since he does not actually have Asperger's.
No more real names, people. Privacy is important.
(Anonymous)
Debunking the myths of Asperger Syndrome
Well, I may not be Asperger's, but if there's one thing for sure...I'm a nutterbar. Dang!! Oh, and you know those...manic episodes I mentioned previously. Well, someone forgot to take their Lamictol *hint: the author of this trippy pineapple grenade (trying to substitute for 'clusterfuck') here.
Okay, well, now that my rational mind has presided and I'm less...insane...I would have to say that there is an overflux of people diagnosed with aspergers. I just really think that it's overdiagnosed, and as I mentioned before, I really think that it should be recategorized as HFA. And in many of the patients which I've observed, they have characteristics similar to AS, but without the cognitive deviations of autism. They also, like myself, outgrow these characteristics. I really think that reasoning for their diagnosis is due to the fact that they are going through a rough period, and not due to a pervasive developmental condition. Because a lot of these people merely have characteristics that are falsely attributed to Asperger's, without the cognitive deviations of autism. And you can't have AS without the autism. So in this case, it is a misdiagnosis, and not a pervasive developmental condition. However, even with people who truly do have a pervasive condition such as HFA, they can overcome the cognitive-behavioral aspects of it to be fully functioning, socially-adjusted people. And a lot of these people who, like myself, were misdiagnosed with AS, are very good socially. And I, myself, am very socially-adjusted, except I would have to admit, of course, that my hyperactivity tends to make me look a bit of a hooligan. And I do apologise for that; i'm really just tryin' to release some things. I'm a really laid-back, down-to-earth person, so I like to be colloquial with people. It's just how I am. I have a little...too much...personality, I have to admit. Just lemme know when to simmer down some, and I will abide by that. But I really do think that AS is largely misunderstood to be some vast imparity *hahah, I like neologisms* to one's functioning, but that is completely false. In fact, many with AS are suprafunctioning, and perceive things on a completely different level than even I can tap into. I mean, that's why I know I don't have AS; these people are far more intelligent than I am, and far more mathematical, imaginative or abstract than even I can comprehend. Their logic resides on a completely stratospheric level that even I cannot relate to. I don't know how they do it...they're miracle-workers. The thing is, I wonder how they synchronize things together. I'd be so intrigued to learn their logic...if you could provide me with any feedback, that would be wonderful. I'd love to learn how they compartmentalize information, and connect things together. Would be fascinating...
(Anonymous)
pardon my verbal diahhrea, which created unintended sensory overload..
Debunking the myths of Asperger Syndrome
I really contend the perspective that AS is a disability. As a researcher, I have honestly observed and studied people who have characteristics similar to that of AS, but without the cognitive deviations associated with AS. These people were misdiagnosed with AS, as I had been when I was 17 (I was also misdiagnosed with bipolar then, because I had simply been going through a rough period, and I was able to outgrow a lot of the characteristics associated with Asperger's as well as my bipolar depression.
I would have to say that there is an overflux of people diagnosed with aspergers. I just really think that it's overdiagnosed, and as I mentioned before, I really think that it should be recategorized as HFA. And in many of the patients which I've observed, they have characteristics similar to AS, but without the cognitive deviations of autism. They also, like myself, outgrow these characteristics. I really think that reasoning for their diagnosis is due to the fact that they are going through a rough period, and not due to a pervasive developmental condition. Because a lot of these people merely have characteristics that are falsely attributed to Asperger's, without the cognitive deviations of autism. And you can't have AS without the autism. So in this case, it is a misdiagnosis, and not a pervasive developmental condition. However, even with people who truly do have a pervasive condition such as HFA, they can overcome the cognitive-behavioral aspects of it to be fully functioning, socially-adjusted people. And a lot of these people who, like myself, were misdiagnosed with AS, are very good socially. And I, myself, am very socially-adjusted, except I would have to admit, of course, that my hyperactivity tends to make me look a bit of a hooligan. And I do apologise for that; i'm really just tryin' to release some things. I'm a really laid-back, down-to-earth person, so I like to be colloquial with people. It's just how I am. I have a little...too much...personality, I have to admit. Just lemme know when to simmer down some, and I will abide by that. But I really do think that AS is largely misunderstood to be some vast imparity *hahah, I like neologisms* to one's functioning, but that is completely false. In fact, many with AS are suprafunctioning, and perceive things on a completely different level than even I can tap into. I mean, that's why I know I don't have AS; these people are far more intelligent than I am, and far more mathematical, imaginative or abstract than even I can comprehend. Their logic resides on a completely stratospheric level that even I cannot relate to. I don't know how they do it...they're miracle-workers. The thing is, I wonder how they synchronize things together. I'd be so intrigued to learn their logic...if you could provide me with any feedback, that would be wonderful. I'd love to learn how they compartmentalize information, and connect things together. Would be fascinating...
(Anonymous)
Re: pardon my verbal diahhrea, which created unintended sensory overload..
I agree--it is really no more than autism without speech delay; but I think it's presumptive to say that it is never (or even not usually) a disability. It is a different way of life, and there's nothing shameful about it; in fact, most have much more trouble with prejudice and other hostile environments than from autism. However, the cognitive differences produce a situation in which what you can do is not what society expects of you, and that is the definition of a disability.
AS plus high intelligence often results in someone who is able to "fake normal". That does not mean that he IS normal, because he still thinks differently and still puts out much more effort to socialize than NTs do. Additionally, he will still have the "activities/interests" subgroup of traits: Strong interests; repetitive movement; routines. And there's very little you can do to "overcome" sensory sensitivity. You have to work with that--keep your stress level low.
You're focusing overmuch on social skills... Social skills can be learned. In adulthood, AS looks different than it does in children. AS adults have often learned enough social skills to "pass" despite having a drastically different way of thinking than most people around them. That doesn't make them non-autistic; they won't lose their diagnosis unless they started out with such a mild case of AS that it just barely touched the diagnostic borderline.
AS can be misdiagnosed. It can be overdiagnosed. But it is real, and it is not just being a "nerdy genius". People with AS often have learning disabilities, often have to deal with executive dysfunction, often come down with mental illnesss (being big targets for bullying, exclusion, prejudice, and abuse probably contributes a great deal to this problem).
Also, every Aspie is different from every other. Aspie #1 is a dyslexic, scatterbrained artist; extroverted chatterbox oblivious to social mistakes; spends six hours a day drawing a web comic. Aspie #2 is an introvert with no friends who is fascinated with an online game, where socializing is easier; he tends to have social anxiety and does well at mathematics. Aspie #3 learned to read at age 3 and has never stopped since. He devours information on every subject possible; but he has bad grades because he's horrible at taking tests and can't fit himself to the standardized way of learning. He hangs out with the "weird" kids and has some satisfying relationships. Aspie #4 secretly loves a kids' cartoon show, but keeps his fascination secret because he knows it's "weird". He's painfully aware of his low social skills and spends every day of his life carefully analyzing every action and word for normality. As a result, his social skills are much higher than most Aspies', but he also suffers a lot of anxiety and spends a lot of time feeling as though others would reject him if they knew who he "really" was.
These are pretty typical cases for Asperger's. The "nerdy genius" stereotype is just not true of most of us.
(Anonymous)
(Anonymous)
(Anonymous)
Autism is not primarily behavioral; it is neurological. There are structural differences between the brains of autistic and non-autistic people (that includes Asperger's autistics). And it starts, in most cases, at birth; and in almost all cases before the age of three.
Autism is inherited. An identical twin of someone on the autism spectrum is 95% likely to have some kind of autism himself, though he is only 50% likely to have the same kind of autism. There is a lot of variation from person to person; it is thought that small differences in the prenatal environment, especially, can change how an autistic brain develops. (In the case of twins, remember that the prenatal environment can be and often is different for even identical twins. I am an identical twin; my twin died before birth; I was born healthy. Case in point.)
Additionally, while autistic people are introverted more often than they are extroverted, autistic extroverts exist. So do autistic people with every other personality type. Autism affects personality and cognition; but it is not just a kind of personality.
There are a lot of other neurological conditions associated with autism. Seizures are common. So is face-blindness (the inability to memorize faces). So are learning disabilities of all kinds. Tourette's. ADHD. Sensory-integration disorder. Dyspraxia. All of those are neurological in origin.
And if you think it is "easy to overcome" Asperger's, then you have never tried to overcome Asperger's. Learning social skills is possible; but it is as hard as learning to read while being severely dyslexic. You may learn them; but you will always have to work very hard to use them. And then you have everything else still to change: The need for routines; the love of specialist subjects; the odd speech and body posture... Some of those things simply can't be changed. There's only so much a human being can do at one time, and for someone with Asperger's, it's very hard to fake typical for a short period of time and impossible for long periods of time.
Trying to "overcome" Asperger's, rather than working with it, leads to such high levels of stress that mental illness is almost inevitable. I had to spend time in a mental ward before I knew that; though, in my defense, at the time nobody knew I was autistic, and trying harder was the only solution anybody had ever told me to use. Trying harder didn't work.
The feeling of "trying harder", of faking normal, is like running too many programs on an old computer... Sooner or later, there is simply not enough processing power left, and you lock up. Being very intelligent doesn't protect you from that, because the brain, unlike a computer, doesn't have a single CPU. The processing you use for socializing is different from the kind you use for math; and if you have Asperger's, your brain is made in such a way that, whatever your other talents may be, your social area works slowly and inefficiently. You can only do so much with that. The solution isn't opening program after program and hoping your computer will learn to speed up; it's using the processing power you do have in an intelligent and creative way. If you don't have the processing power for eye contact, then don't make eye contact. If you get tired out from interpreting speech, then use e-mail. Work around things. Don't bash your head against a brick wall--literally or figuratively--because you will only do damage to yourself and possibly others.
If you want to live a good life with autism, it is not worthwhile to try to become non-autistic. You are much better off finding workarounds, finding your own ways to do things, pursuing your own goals in your own way without chasing after an ideal "normal" that is not YOUR ideal at all.
(Anonymous)
Conversely, those with more pronounced neurological features of autism would most likely not recover from them. That having been said, allow some reassurance in the fact that I have observed cases of high-functioning individuals who have matriculated out of the spectrum. A recent client of mine had a son who was high-functioning autistic, and in a three-year timespan, I have seen him mature from a child who would make no eye-contact to one who can carry on entire conversations with you, so I have seen it happen; and it can very well be done. Again, it depends on the severity of the case and the type of treatment program they embark on. The ABA program is used in the clinic, and the majority of reported cases have demonstrated a significant improvement from it. But the prognosis itself is very case-specific, and dependent on level of severity.
(Anonymous)
Re: Debunking the myths of Asperger Syndrome
I disagree with your statement that you can't have AS without autism. I'd like to know where you got that information so I can learn more.
Someone's Mom with AS
(Anonymous)
People with Asperger syndrome are NOT disabled, but DIFFERENTLY-ABLED
(Anonymous)
Re: People with Asperger syndrome are NOT disabled, but DIFFERENTLY-ABLED
(Anonymous)
Last post continued.....I promise I won't write this much again - oy- I'm just really into advocacy
(Anonymous)
AS and meds
i hate that AS is classed as a disabiltiy but tbh it is and it aint a nice one as it messes with the mind loads
take a person off there meds and they wont tell they are off them and they start feeling confused i know it happend to me took off meds for test without knowing i was off untill i got told i lost a relationship in those weeks off and i never got it back
(Anonymous)
asperger
Re: asperger
(Anonymous)
Removing Social Stigma of Mental Disease, Disorder, Different...
My thought is that if we, as a society, accept that mental illness is not caused by bad behavior and should be treated with the same medical awareness and programs as we would, let's say for Cancer or Autism, could we identity and treat children early enough that they have learned coping skills before acting out in a way that is harmful to themselves or others. Mind you I have no idea what was behind the events in Colorado. I am only certain that this person is not healthy.
It concerns me that we are afraid to address one disease with a stigma attached to it because of how it might relate to another disease or disorder, that has become more "socially acceptable". I know the programs and funding etc do not exist. But does that mean we should continue ignoring the obvious problem that does exist. I also realize that not ever person with mental illness has extreme behavior. But again, does that mean we should continue to overlook those that have chronic health issues related to the mind. What if we could help some of these ailing people and in turn prevent the massacres that seem to me so preventable.
I read thru your blog and comments here. It seems that you have an excellent view of this world and am interested in your thoughts.
Thank you,
(Anonymous)
Am I an Aspie?
Re: Am I an Aspie?
The end of the world sounds boring. All the interesting things in the world seem to involve people, at some level.