Slate recently published a great article about the problems queer autistic people have with doctors and the LBGTQ scene. Neurodiversity activists are featured prominently, but the author is a neurotypical doctor. I appreciate the gesture of him writing the article, but I still get the sense that he’s missing something. He describes the event that struck him:
As a physician, it’s never comfortable to stumble across an area where you don’t know as much as you should. For me, such a realization came not long ago when I spoke with a young gay male patient who was also autistic. As we talked, it occurred to me to ask how being autistic affected his ability to meet potential partners, and whether he found it challenging to interact with non-autistic (or neurotypical) gay men. That people who are both autistic and LGBTQ might face unique challenges in a majority straight, neurotypical world simply hadn’t dawned on me before then…
[stuff about how disabled people are more accepting of LGBTQ people than vice verse]
I am sorry to admit this pervasive ableism has too often informed the way I’ve interacted with autistic patients, LGBTQ or otherwise. Regardless of their gender or sexual identity, autistic and other disabled patients have every right to have those identities acknowledged by their medical providers. Everyone who delivers care to autistic patients should be sure they’re aware of the full person in front of them, not a preconceived notion of what they may or may not understand about themselves.
It was also dismaying to see how many people told me they don’t tell medical providers they are autistic because they fear being patronized or dismissed. Just as LGBTQ people should feel no inhibition from sharing information about themselves with their physicians, people with any kind of disability should be able to walk into a doctor’s office and feel confident they’re going to receive care that is respectful and meets their needs. Clearly the medical community has work to do when it comes to how we care for our autistic patients…
His understanding of intersectionality is not-quite-right. The commenters trolls make the mistake a lot more blatantly. For example, the top-rated comment:
How about autistic LGBTQ people of color who are Muslim? Are people passionate enough about empowering them? How do they know when they are receiving a trigger warning for a microagression?
The next one:
Autistic LGBQT is now a thing? Geez I haven’t even sorted out all the cis-gender definitions and now I have to add this one? If I’m not paying attention do I have LGBQTADD?
A few further:
dear lord. now we have the worry about the autistic, LGBTQ micro-segment of the population.
Won’t somebody think of the physicians being dicks to their patients?
When are we going to get an article about those poor physicians who are expected to be well versed in every possible unique characteristic their patients could possibly have and any possible interaction of those characteristics?
Look, everyone has their own challenges and issues. Find a good GP or health care coordinator who can address whatever your biggest issue is and help bridge the gap, but don’t expect everyone in the universe to be able to cater to every issue you have.
It’s said that autistic people struggle with abstraction and “weak central coherence”:
I’m noticing parallels between what normal people say about autistic people, on the one hand, and what white men say about everyone else, on the other. A big part of talking about hated groups involves projection.
I have a ton of social anxiety, but I don’t worry a lot about offending people based on their identity. It seems like white people have anxiety about it to the point of irrationality. Some of it is simple familiarity. I grew up in a variety of situations: being a “native,” living “overseas” in a country where I spoke the language, and living overseas in a country where I didn’t speak the language. It was definitely possible for me to play with other kids despite language problems. Most likely, it made goofy autistic things I did get attributed to being a foreigner who doesn’t speak the language. I met people from all over the world, for one reason or another. One of my closest friends is gay. I learned how to happily have the same conversation in circles with my senile grandmother, because that’s how to be kind. My dad was functionally illiterate and had poor cardiovascular health. We got to park in the disabled spaces and have people stare at us like we didn’t deserve it! A great source of frustration was hearing my dad say we need to “agree to disagree” when I was arguing with my mom about religion. An atheist and a Jehovah’s Witness can be successfully married, self-evidently (to me).
On the other hand, those are just individual cases of peacefully coexisting with different people. While I might have a learned familiarity with certain kinds of differences, and general knowledge from reading, it’s straightforward not to dehumanize people. You start with the assumption that everyone is equal as a human and go from there. Everyone is unique, but it’s also true that people are more alike than different.
The way to work with “diverse” people is simple: approach them with good will and consideration. Use your imagination, your advanced normal person perspective-taking abilities, and logic. Be flexible. Try. It’s an ethical stance. It’s dispositional.
Our society is decadent. As a result, what might’ve once looked like moral impairment is considered normal. People are unwilling to approach everyone from a fundamentally ethical stance. Using logic rather than emotional impulses to make moral decisions is an autistic adaptation, but it’s also the definition of moral philosophy. “He that has never doubted the existence of matter, may be assured he has no aptitude for metaphysical inquiries (Turgot).”
The problem with the trolls quoted above is that their thinking is so concrete, specific, and case-by-case. They’re relying on memorizing details, and of course that becomes cognitively overwhelming if you have to learn lists of things not to do in order to avoid offending every group of people imaginable. People are always joking about the fact that there are so many possible combinations of labels (this is one way that normal people enjoy math without self-awareness).
The normal people are using a strategy for dealing with other people that’s not only cruel and dehumanizing, but also too cognitively inefficient to work correctly. Somehow they can’t stop putting their feet in their mouths! It’s because of their commitment to being dicks, not because it would be so incredibly hard to be nice to someone with a lot of labels.
I’m a vegan anarchist-sympathizing third culture kid military brat half-German autistic mulatto. I’m at least a little bit high most of the time. I practice Buddhism in an attempt to be nicer and more empathetic. Just don’t say racist or patronizing shit to me. Are you retarded or something? It seems like that would only be hard if you had some kind of commitment to being an asshole. Someone who’s open to the idea that they make mistakes can acknowledge them and correct them. The effort is even appreciated by a lot of people more than it is by me! They wouldn’t even write a super critical blog post about the person doing the best job of being an ally!
The tragedy is that normal people are using the wrong strategy for interacting with others, to the extent that being nice is a goal, but they don’t realize it. They get overwelmed and then blame the vulnerable people for their frustration and stay closed-minded forever.
There’s no expectation that every individual doctor would be familiar with every subtle effect of autism on everything. They don’t need to be. They just need to stop approaching people in a way that would make anyone feel bad, including themselves.
The author of the article is trying, but he’s veered off-track. This is the EXACT same problem that people have with math. Normal people struggle with mathematical abstraction, too. They misunderstand math as a step-following exercise, instead of a logical reasoning exercise. At some point, the concrete steps to solve a problem will get very involved. Computers help with those things, because rules for doing the computations can be given at a high level of abstraction, and the concrete steps of solving the problem can be automatically derived from the program instructions.
In other words, there’s an easy way and a hard way of thinking about the problems. In the hard way, you have to learn recipes that get longer and longer. The steps are arbitrary. You’re in the Chinese Room. In the easy way, you see the pattern, so it’s simple to figure out what you need to do on-the-spot.
Common Core is another instance of normal people not understanding abstraction and fucking everything up. When I was tutoring, I died a little inside when a 4th grader was almost crying in frustration because “math changes all the time.”
Normal people have never considered that, in olden times, autistic people might’ve been authorities they deferred to, like clergy.
It sort of makes me happy just thinking about it, having a big hood draped over me with a peaceful routine and there’s no talking and I can think deep thoughts about the universe all day every day and do everything ritualistically perfect a million times. Elective mutism.
The misinformation can be extremely pernicious. The first comment in the section is a big justification of dismissing autistic LGBTQ people, based in knowing just enough math to be harmful. “JustAnotherEngineer” says:
About 1 out of 68 births may be somewhere on the Autistic Spectrum.
About 1 out of 40 people identify as somewhere in the LGBTQ community.
The chances (assuming equal distribution) of someone being in both groups (in the overlapping part of the Venn diagram of the two groups) is about 1 in 3000.
The average doctor may see as many as 2000 patients a year.
The chances a doctor (other than a specialist) will be able to have the frequency of patients to develop any kind of expertise in this particular condition is unlikely. The likelihood an average GP will ever encounter an autistic LGBTQ patient is less than 1 patient per year.
Further, because of these numbers, the economic value of adding such a sub-specialization to the average doctors workload/knowledge tool kit is not sufficient to make it worth doing (they will forget what ever they learned before they ever encounter a need to use the knowledge)…. which is why GPs send so many patients onward to specialists if (especially in the case of cancer) the patient has something outside the “normal range and distribution” of issues the GP deals with.
So if you are autistic AND LGBTQ, best if you move to a major city center where population density might justify the existence of 1 or 2 specialists who are trained and aligned to deal with your issues.
Surprisingly, someone jumped in to do God’s work and point out the problem (not that most people will care):
@JustAnotherEngineer “The chances (assuming equal distribution) ”
Traits are often clustered in populations due to genetics, environmental factors, and random chance. Equal distribution may not be a valid assumption.
This is ALSO not-quite-right. Equality of distributions is something you have to confirm is true when you’re doing statistical tests comparing two or more groups. Some tests (“parametric”) depend on the distributions of data in each group. It doesn’t make sense to compare a bell curve with a bimodal distribution. What that means is irrelevant because this is not a situation of statistical testing.
This person has the right mathematical intuition, though. The engineer and this commenter have different styles of understanding math. The engineer is better at calculating. The person responding thinks about math in way that’s probably closer to the way I naturally think about it. I love to read all about math, but I don’t like doing the proofs or calculations. I just like to think about, I don’t know, combining things.
Here, it’s like two blind people and an elephant. In terms of data analysis, the assumption that’s important here isn’t equality of distribution. It’s the assumption of statistical independence, i.e., the assumption that being autistic and being LGBTQ are completely unrelated (0 correlation). That’s an empirical question we have the answer to: gender dysphoria and autism are related because autistic people miss some of the gender socialization cues (plus more speculative biological reasons). Therefore, JustAnotherEngineer’s cute trick of multiplying 1/16 by 1/40 to get 1 in 2720 IS NOT A VALID MATHEMATICAL DESCRIPTION OF REALITY.
Sometimes I feel like the only person who knows about autism, math, and queer theory at the same time. < 1/2720. Abuse of notation.
My original thinking usually comes from combining special interests in some way. I’ll notice patterns in my thinking across both topics…
Visually, the thread is dominated by a very wrong but superficially convincing bullshit complaint about having to be nice, with a weak suggestion of the problem using the wrong terminology. The assholes always win, rhetorically.
There’s the social retard, rambling about the fine points of statistical assumptions. Can’t I see we’re talking about serious business oppression stuff?
Both sides are misusing the other side’s terminology. Consider the top-rated comment again.
How about autistic LGBTQ people of color who are Muslim? Are people passionate enough about empowering them? How do they know when they are receiving a trigger warning for a microagression?
A trigger warning is giving a friend a heads-up that we’re going to be talking about some awful shit. It’s lame, but it’s intended to be friendly. A microaggression is when a racist person takes their racism to be such a fundamental part of reality that their offhand remarks are fucked up. One is a thoughtful gesture. The other is a type of hostile inconsideration. Therefore, the same individual wouldn’t provide a trigger warning that they’re about to micro-aggress against you. It would be more overt aggression in that case. The troll just knows those are terms used by people he hates and he doesn’t care if he’s writing word salad. The point is we can tell he has contempt for what we’re saying.
THE ENTIRE CONVERSATION IS DUMB AS FUCK BECAUSE THE NORMAL PEOPLE REFUSE TO EMPATHIZE OR LEARN THE DETAILS OF ANYTHING OR REASON ABSTRACTLY. WE CAN’T GET ANYWHERE AND IT MAKES ME WANT TO SELF-INJURIOUSLY STIM IN FRUSTRATION.
Every “identity politics” movement shipwrecks here. You can’t cooperate with a group of people that doesn’t want to cooperate, no matter how hard you try. They very much PREFER the right to view me as subhuman on multiple levels. They’ll deny this and call it a theory of mind impairment. Projection, again. See the pattern?
It just goes on and on. Matt1234 graces the thread with his presence.
Matt1234: I feel for the plight of this particular patient, and for autistic folks.
I do not like the idea of the medical community using the bogus term “neurotypical” though.
The difference between folks with autism and the folks without autism is that one of these groups has a disease.
Wintermute: You haven’t heard that they have a lobby now? Autism is a neurological gift from our evolutionary past.
Matt1234: What I don’t like is the putting of normal in quotes. I had a big argument on one of the Prudie threads recently about autism. People did not like me calling it a disease. It is they argue, like you imply, “just another pattern of brain operating”. That is BS. It is a crippling problem. Lots of people do a great job of coping with it and overcoming it, and indeed maybe even somehow seeing the world in a better way than we do. But for every math whiz with the diagnosis of autism there are 100 folks in assisted living who cannot talk.
Matt1234 didn’t do a Google search to see how many autistic people are nonverbal (25%). He SURELY doesn’t understand how loosening the diagnostic criteria would increase the “average autistic person’s” IQ. He doesn’t read Spectrum News:
The study, published 7 October  in PLoS One, shows that children with autism who have IQs below 85, the low end of the average IQ range, show cognitive problems similar to those of controls with equivalent IQs. But children with autism who have IQ scores higher than 115, the high end of the average range, do much worse on cognitive tests than do controls with similar IQs.
The findings suggest that low intelligence underlies cognitive deficits in only some children with autism. In children with autism who score well on IQ tests, these problems may stem from other origins entirely, says lead researcher Nanda Rommelse, associate professor of psychiatry at Radboud University in Nijmegen, the Netherlands.
If the results hold up, therapies that target cognitive skills may turn out to be especially beneficial to intellectually gifted children with autism.
The results also call into question the common conception that a high IQ equates to ‘mild autism,’ given the spectrum of cognitive problems that remain, says Sarah White, senior research fellow at University College London’s Institute of Cognitive Neuroscience, who was not involved with the study.
“This paper would caution against using such a term,” she says. “Rather, it indicates that autistic individuals with high IQs are actually purer cases of autism without additional difficulties.”
I don’t even care if the “pure case” business is true, for these purposes. It’s mostly important that Matt1234’s posts bear no resemblance to the way people who know what the fuck talk about these things.
Matt1234 is chest-beating. It got Donald Trump elected, because normal people are impressed by that. In many ways, normal people have failed to learn nonviolent ways of dealing with their anxieties and dislikes.
I think it’s obvious why I’d spend mental energy on this tiny soon-to-be-forgotten exchange on the internet: I’m a straight man, but all of these people basically took to the internet to argue forcefully that I should receive across-the-board worse medical care because fuck autistic people (especially of color). I have to defend my preference for dignity at the doctor’s office.
This is what I struggle with: what’s the motivation of the trolls and the millions they speak for, insisting on their right to keep me in my place? Why do they feel so comfortable laying down the law, socially? What did I ever do to them? Why is it important to them that my way of thinking is discredited and pathologized, when I’ve found productive ways of applying it to the general upkeep of the internet at work? I’m a bit aloof and weird, but I qualify for hardworking taxpayer status just like they do. I didn’t ask for disability accommodations, not knowing I was autistic, but I was reliable enough over a long period of time that people stopped caring what I did on a day-to-day basis. If there are no problems, there are no problems…
What’s crippling is, like, the noise from the foosball table. I understand (intellectually) that it’s probably good for the bottom line of the company that people can goof off and play foosball at 4 PM and stand around talking. The best solution to the dilemma is easily implemented: I work from home, where I have more control of my environment. Without calling it that, my sensory sensitivity has been accommodated in a way that I’m not stigmatized or anything, just like how it’s supposed to work. I got diagnosed to maintain the status quo. It’s like…help me help you.
As a further benefit, I’m spared about an hour in my car each day, which is quite a lot of stress relief, over time. Most of my nail picking and nail biting happens when I’m driving. Why do I have to do that for 30 minutes twice a day just to do work on the internet when I get there? I gas up my car once a month. Fewer greenhouse gas emissions.
For emotional reasons, working from home just pisses people off, though. Given the opportunity, I argued for everyone else’s right to work from home, and people didn’t join my crusade. I’m not trying to take anything away from them because I’m special. I have in fact received government assistance at times: social security payments as a dependent of my dad’s, scholarships and fellowships, a short stretch of unemployment. I’d have no problem voting for socialist candidates to spread the wealth. I’d love to.
It’s as if the normals are lacking some kind of mental schema for civic cooperation. Projection, again.
End of attention span for this topic right now.