Tony Attwood’s The Complete Guide to Asperger’s Syndrome has a chapter on psychotherapy that completely contradicts my experience of psychotherapy. This is a continuation of a book review that started in an earlier post. There, I take issue with Attwood’s positions on honesty and special interests. Here, I take issue with his advice that psychoanalytic therapy is worthless for people on the autistic spectrum:
In my opinion, traditional psychoanalytic psychotherapy has very little to offer a child or adult with Asperger’s syndrome, an opinion shared by some psychotherapists (Jacobsen 2003, 2004). However there are published case studies that have used traditional and modified psychoanalytical psychotherapy (Adamo 2004; Alvarez and Reid 1999; Pozzi 2003; Rhode and Klauber 2003; Youell 1999). The detailed psychoanalysis of the mother and infant relationship can be irrelevant to understanding the mind of a child with Asperger’s syndrome, and lead to the mother developing considerable guilt and the child being very confused. Asperger’s syndrome is not caused by an inability of a child’s mother to love and relate to her son or daughter. This may seem obvious, but unfortunately, in some countries, such as France, the traditional psychoanalytical concept of autism and Asperger’s syndrome is the dominant theoretical model and the basis of treatment.
In 2012, there was a documentary called The Wall about the absurdity of using Lacanian psychoanalysis for non-verbal autistic children. At that time, an autistic person with a special interest in Lacan spoke up for psychoanalysis in The Guardian:
I am a person with a diagnosis of autism, and I am also a scholar of the work of Jacques Lacan. I would immediately admit that psychoanalysis is probably not the best therapy for many of the children seen and referred to in the film. In respect of my Asperger’s, I have been in analysis with a Lacanian shrink and I have had cognitive behavioural therapy (CBT) with an NHS psychologist. The CBT is better when dealing with practical issues – in my case, work on, say, my notorious social bluntness. I work to improve my “social skills” because it is a problem I have identified, and CBT works pretty well to enable me to build up my “coping strategies” and recognise social cues better.
On the other hand, in the psychoanalytic session, what you want or demand consciously is of no real consequence: psychoanalysis after all, is the narrative of the unconscious. Except that, if you are a Lacanian, the autistic person does not actually have an unconscious, they are instead, Lacan said, “spoken by the real, possessed by language”. From this one example we can see that the insistence of the Lacanian on psychoanalysis as a kind of insoluble existential crisis could be understood as brave, extremely liberal and even subversive: for the Lacanian, what society wants just fades away, it has no currency.
For Lacan, analysis is about putting desire into words, speaking the truth of desire, not giving ground on one’s desire. Antigone is Lacan’s model of the pure ethical act. I just lost time compulsively reading about Antigone, but for now I need to stick to the plot: Tony Attwood.
I’d like to think the content of this blog is evidence that psychoanalysis has more than “very little” to offer a person who’s also autistic.
It’s true that failures of maternal care don’t cause autism. It’s also true that autism can go along with maternal stress, depression, and anxiety, and those things do have harmful effects in early childhood. It’s safe to say that all of the above factors have an effect on the mother’s facial expressions:
Children also pick up on the caretaker’s anxiety, which makes them anxious.
Attachment theory isn’t controversial. It’s not some kind of archaic Freudian thing that childcare affects children.
Over and above a mild case of autism, I have maternal rejection issues that have more to do with the Jehovah’s Witnesses. Along with rejection by peers, those things can produce “schizoid personality,” in the sense of old-fashioned psychoanalysis jargon. It overlaps with modern schizoid personality disorder, avoidant personality disorder, and features of autism.
I was reading Nancy McWilliams stuff pretty early in therapy. Consider the following quotes in light of autism:
I have been impressed repeatedly with the phenomenon of the highly creative, personally satisfied, and socially valuable schizoid individual who seems, despite an intimate acquaintance with what Freud called the primary process, never to have been at serious risk for a psychotic break. The arts, the theoretical sciences, and the philosophical and spiritual disciplines seem to contain a high proportion of such people. So does the profession of psychoanalysis. Harold Davis (personal communication) reports that Harry Guntrip once joked to him that “psychoanalysis is a profession by schizoids for schizoids.” Empirical investigations into the personalities of psychotherapists now ongoing at Macquarie University in Sydney, Australia (Judith Hyde, personal communication) are finding that although the modal personality type among female therapists is depressive, among male therapists, schizoid trends predominate. My own guess about why this is so includes the observation that high-functioning schizoid people are not surprised or put off by evidence of the unconscious. That is, they have intimate–and at times uneasy–familiarity with processes that in most people are out of awareness, an access that makes psychoanalytic ideas more accessible and commonsensical to them than they are to those of us who spend years on the couch hacking through repressive defenses to make the acquaintance of our more alien impulses, images, and feelings. Schizoid people are temperamentally introspective; they like to wander among the nooks and crannies of their mind, and they find in psychoanalysis many evocative metaphors for what they find there. In addition, the professional practice of analysis and the psychoanalytic therapies offers an attractive resolution of the central conflict about closeness and distance that pervades schizoid psychology (cf. Wheelis, 1956).
The psychoanalytic use of the term schizoid derives from the observations of “schisms” between the internal life and the externally observable life of the schizoid individual (cf. Laing, 1965). For example, schizoid people are overtly detached, yet they describe in therapy a deep longing for closeness and compelling fantasies of intimate involvement. They appear self- sufficient, and yet anyone who gets to know them well can attest to the depth of their emotional need. They can be absent minded at the same time that they are acutely vigilant. They may seem completely nonreactive, yet suffer an exquisite level of sensitivity. They may look affectively blunted while internally coping with what one of my schizoid friends calls “protoaffect,” the experience of being frighteningly overpowered by intense emotion. They may seem utterly indifferent to sex while nourishing a sexually preoccupied, polymorphously elaborated fantasy life. They may strike others as unusually gentle souls, but an intimate may learn that they nourish elaborate fantasies of world destruction.
The term may also have been influenced by the fact that the characteristic anxieties of schizoid people concern fragmentation, diffusion, going to pieces. They feel all too vulnerable to uncontrollable schisms in the self. I have heard numerous schizoid individuals describe their personal solutions to the problem of a self experienced as dangerously fissiparous. They include wrapping oneself in a shawl, rocking, meditating, wearing a coat inside and out, retreating to a closet, and other means of self-comfort that betray the conviction that other people are more upsetting than soothing. Annihilation anxiety is more common than separation anxiety in schizoid people, and even the healthiest schizoid person may occasionally suffer psychotic terrors such as the sense that the world could implode or flood or fall apart at any minute, leaving no ground beneath one’s feet. The urgency to protect the sense of a core, inviolable self can be profound (Elkin, 1972; Eigen, 1973).
I suspect that one of the reasons I find people with central schizoid dynamics appealing is that withdrawal is a relatively “primitive,” global, encompassing defense (Laughlin, 1979; Vailliant, Bond & Vailliant, 1986) that can make it unnecessary to use the more distorting, repressing, and putatively more “mature” defensive processes. A woman who simply goes away, either physically or psychically, when she is under stress, does not need to use denial or displacement or reaction formation or rationalization. Consequently, affects, images, ideas, and impulses that non-schizoid people tend to screen out of their consciousness are freely available to her, making her emotionally honest in a way that strikes me and perhaps other not-particularly-schizoid people as unexpectedly and even breathtakingly candid.
Complicating their adaptation to a world that overstimulates and agonizes them is the experience of invalidation and toxification by significant others. Most of my schizoid patients recall being told by exasperated parents that they were “oversensitive” or “impossible” or “too picky” or that they “make mountains out of molehills.” Thus, their painful experiences are repeatedly disconfirmed by caregivers who, because their temperament differs from that of their child, cannot identify with his or her acute sensitivities and consequently treat the child with impatience, exasperation, and even scorn. Khan’s (1963) observation that schizoid children show the effects of “cumulative trauma” is one way of labeling this recurring disconfirmation. It becomes easy to see how withdrawal becomes their preferred adaptation: Not only is the outer world too much for them sensually, it invalidates their experience, demands behaviors that are excruciatingly difficult, and treats them as crazy for reacting in ways they cannot control.
One seldom-appreciated quandary in which interpersonally sensitive schizoid individuals find themselves repeatedly involves the social situation in which they perceive, more than others do, what is going on nonverbally. The schizoid person is likely to have learned from a painful history of parental disapproval and social gaffes that some of what he or she sees is conspicuous to everyone, and some is emphatically not. And since all the undercurrents may be equally visible to the schizoid person, it is impossible for him or her to know what is socially acceptable to talk about and what is either unseen or unseemly to acknowledge. Thus, some of the withdrawal of the schizoid individual may represent not so much an automatic defense mechanism as a conscious decision that avoidance is the better part of valor.
This is inevitably a painful situation for the schizoid person. If there is a proverbial elephant in the room, he or she starts to question the point of having a conversation in the face of such silent disavowal. Because schizoid individuals lack ordinary repressive defenses and therefore find repression hard to understand in others, they are left to wonder “How do I go forward in this conversation not acknowledging what I know to be true?” There may be a paranoid edge to this experience of the unspoken/unspeakable: Perhaps the others are aware of the elephant and have decided not to talk about it. What is the danger they perceive that I do not? Or perhaps they are genuinely unaware of the elephant, in which case their naiveté or ignorance may be equally dangerous.
As an expert on Asperger’s syndrome, Tony Attwood is now technically an expert in a diagnostic category that no longer exists. Surely he intends that “people on the autistic spectrum” and their loved ones continue to read his book? Similarly, we don’t call these patterns of behavior “schizoid” anymore. Or we do, but only in the absence of sensory issues or whatever.
Also notice the similarity between McWilliams talking about schizoid people and Lacan saying that autistic people don’t have an unconscious. It sounded a lot stupider at the top of this post, didn’t it?
McWilliams also mentions the tendency of schizoid people to express emotions by pointing at music, art, and literature that expresses it for them. Attwood makes the same observation about treating autistic people.
Attwood says that a big goal of CBT for ASD is essentially improved mentalization: a richer vocabulary for talking about feelings and an improved understanding of other people’s feelings. I think I accomplished that partly by reading a lot of psychoanalytic books about personality.
Having read about attachment theory and the personality disorders, I could start to see those phenomena around me, at whatever level of intensity.
I used that insight to better understand the emotional factors stopping white people from understanding their own racism.
Identity is apparently abnormal in ASD. Identification is a psychoanalysis topic. This blog is a lot about identity problems shared with non-autistic people, which might superficially resemble the alienation of Asperger’s syndrome.
It’s especially ironic that Attwood says autistic people can’t get anything out of analyzing transference. In fact, someone explaining transference to me was the reason I thought to do therapy myself. Previously, the word “therapy” meant CBT to me, and I definitely wouldn’t want Attwood using his CBT moves on me. I understood the concept immediately: whatever socially retarded thing I do in relationships, I’ll also do in therapy. The way it’s supposed to work is that the therapist then calls me out on it, and it’s kind of undeniable because I’m doing it in that moment. It makes logical sense how that could help a person.
Basically, Attwood’s position is that Asperger’s syndrome explains all of a person’s emotional life, which they’re incapable of reflecting on, anyway. To gain those skills, they should do the same things that happen in psychoanalytic therapy, but it’s only ok if we call those things by different names and stick to the worksheets and do everything in a specific order. Tony Attwood thinks I need a “broader concept of personality,” but it’s like I’m only going to benefit if those broader concepts are perfectly orthogonal (confirmed using factor analysis). If I recognize myself in books that say “Asperger’s syndrome” on the cover AND in books that say “schizoid” on the cover, the only evidence-based thing to do is keep filling out pencil-and-paper forms until my life makes sense. I can’t just…think about whether I see those patterns in my life or not.
Learning theory of mind from novels is a normal, resourceful thing autistic people do. Heaven forbid anybody learns it from a relational psychoanalysis paper that uses the word “intersubjectivity.” Heaven forbid anybody learns it from an old Buddhist text that’s interesting to read. Those people just can’t.
On day 1 of psychoanalytic therapy, I considered myself to have “dysthymia” and wondered whether my social anxiety was a personality disorder or not. I read Psychoanalytic Diagnosis and thought I related to the schizoid and avoidant chapters. I started this blog after a year of that, and I can say more elaborate things about my own feelings and the feelings of other people.
The first year of this blog’s content spans a period where I was reading about narrative therapy and seeing an ACT therapist who was familiar with it. The ACT people bothered jumping through the hoops of making it “evidence-based,” but it’s really just the secularized Buddhism I was already practicing. Now I just had somebody to talk about it with.
I think the narrative therapy was more suited to my actual problems, which have a lot to do with aspects of society that CBT people don’t always acknowledge. Do I really want to talk to Tony Attwood about black people stuff, and how that relates to autism? We know that Tony Attwood likes BMWs. What are Tony Attwood’s thoughts on BMW’s use of concentration camp slaves during WWII?
It’s true that I’m socially awkward. It’s also true that I can go home and try to reason about the situation afterwards. Concepts like attachment theory are very useful for doing that. Then, I can try to be more mindful of those issues in daily life.
Before the word “autism” came up, it did seem strange that I seemed to be making progress the more I understood why everyone around me is emotionally incapable of listening to reason. About anything I care about. Donald Trump, because normal people’s feelings. They have this tribal, “fuck the black people” bonding thing going on, and I’m blind to the positive side of it.
True story: you can zap autistic people’s brains with magnets and they’ll empathize with their bullies.
As for Kim, she says the pain and self-doubt that she felt after the first experiment has receded. And she has more ease now than she did before she glimpsed emotion. This is in part because she understands herself better, sure, but also because after going through the experiments, she sees the world differently than she did before. It’s a more understandable and kinder place.
She says she thinks a lot about one of the videos she was shown during the second experiment. In the video, two employees were saying mean things to a fellow employee named Frank. And Kim says the first time she watched it before the TMS, she couldn’t answer any of the questions that the researchers were asking about it. But after, she understood not just the video but also one of the big mysteries that had dominated much of her life.
KIM: It never made any sense to me as to why people would be mean to somebody else. Why would you be mean to somebody? And what I saw is that when the two employees were there and were talking together and then were giving Frank a hard time, the primary thing was not that they were trying to be mean to Frank. The primary thing is that they were bonding. Those two people were actually building a bond between the two of them. And it was simply the means to do it was to be nasty to Frank. And then I was like oh, maybe that’s what these kids were doing when they were bullying me. The primary thing was that they were bonding. The secondary thing was that I was being bullied.
SPIEGEL: It’s much easier to live in a world which makes sense, a world where people are mean not just for fun, but because they, like everyone else, want to belong and feel safe. That’s the world that Kim lives in now.
I don’t see it as therapeutic to TMS people into loving their enemies. The people that bullied me in middle school surely don’t even know each other anymore, but the effects on me persist. It’s better that I see the injustice of it clearly. We think bullying is normal because we’re a slave society, which is an immoral thing to be. It’s clear and unambiguous, and the feelings of bullies aren’t a valid consideration. They can find another way to make friends, or do without like I sometimes did.
Normal people have a misunderstanding that their feelings matter just because they exist. I understanding intellectually, and can imagine, how it feels good to Other people. I don’t think it’s bad that I lack an intuitive, gut-level resonance with white supremacists. Then I might be as morally confused as they are.
Rationality is the use of procedures to work around the natural biases in our thinking. Tribal loyalty over shared humanity is a distortion of clear moral thinking. I’m apparently less susceptible to it than other people, and the reasons include both autism and life experience.
It’s sad and unsurprising that “neurodiversity” is such a small step from what this blog already was. All the same white man problems, now with more autism. I am now a neurodiversity blogger. I guess that’s how getting diagnosed changed my identity. Half-German ex-Jehovah’s Witness mulatto third culture kid military brat WITH AUTISM. All my dating problems make so much sense, now! This changes everything! I never realized people were making bad assumptions about me because I’m socially retarded! I need to follow Tony Attwood’s advice and talk to someone with specific expertise in weak central coherence theory right away!