the autism people need to have a talk about behaviorism with the mentalization people

I’ve come across two “theory of mind” literatures that seem unaware of each other, separated from each other by the walls of DSM categories. On the one hand are the mentalization people, who worry about attachment theory and borderline personality disorder. On the other hand are the autism people.

The mentalization people have all kinds of ideas about the necessity of parental mirroring for proper affect regulation and understanding of one’s own and other’s mental processes. We have some idea, based in attachment theory, how to raise children that are good at mentalizing.

Isn’t it ironic, then, that the field of autism is simultaneously dominated by behaviorism and complaints that autistic children aren’t developing theory of mind properly?  This entire video of Peter Fonagy is worth watching, but the section on family dynamics starting around 16:00 is especially important to the point I’m making:

I’d like to suggest that “theory of mind impairments” and meltdown nightmares aren’t intrinsic to autism, but instead reflect the harmful way that autistic children are parented by default.

Note that borderline personality disorder is described as resulting from “a sensitive child in an invalidating environment.” About that…

Imagine that mommy is sleep-deprived and daddy really pissed her off this morning, etc. She has flat affect for whatever reason.  Now watch this video of a still-face experiment:

What’s so bad about ABA?

Complex PTSD also includes a “feeling of being completely different from other people.” Autistic women get misdiagnosed as borderline.  DizzyDollie7 asks, “How did y’all get y’all’s PhDs?”

This vignette from An Early Start for Your Child with Autism sounds like childhood memories of my dad:

Matthias was the child who had very little interest in objects. He preferred to lie on the back of the couch and look out the window most of the time. His dad could not figure out how to interest him in his toys, and after each attempt Matthias returned to the couch. So Matthias’s dad tried a different approach to interact with Matthias. The next time Matthias walked toward the couch, his dad lifted him up and dropped him onto the couch. He repeated this game a few times–helping Matthias climb off the couch, lifting out his arms to pick Matthias up, and dropping him onto the couch. Now Matthias started to understand the game, and after falling, he walked over to Dad to be picked up and dropped again.

In trying to figure out what Matthias enjoyed, his dad realized that Matthias enjoyed more than just the couch, and smiled and came back for more when he was tossed into the air. So Dad experimented a little with some other “movement” games. He found that Matthias loved being flipped up onto his shoulder and “airplaned” around the room, loved being bounced actively on the big exercise ball; loved having his dad flip him onto the bed and push on his chest with a pillow; and loved being dried roughly after his bath with a big towel and a lot of action. During these kinds of activities, Matthias was much more likely to laugh, smile, look at Dad, and pull on Dad to repeat the game.

Imagine that. The child enjoys it when his father is playful. If the last two paragraphs are unusual for children with autism, doesn’t that explain a lot?

Read an example from further along in the process, while thinking of attachment theory:

Also, any time Matthias needed help that involved an object (taking something out of a container, opening a snack item), Dad took Matthias over to the family room or kitchen table and had him sit down before helping. Matthias started to learn about other locations in the house besides the couch where fun and enjoyable things could happen.

That sounds horrible to me. The child has to go through a weird ritualistic context-disrupting submission ritual as punishment for needing help with anything at all. Per attachment theory, it’s important for children to feel like their caretaker is a secure home base who won’t abandon them or be cold to them in their time of need. Marcel Proust barely got out of bed a lot of the time, and we still like him.

This is how the book trains caretakers to act, in their role as sustenance-providers the child depends on completely:

Place your child’s cup on the table out of reach but within sight, hold it up in front of your child, and ask if he wants it before handing it to him. Put just a little in the cup, so he will quickly finish and need more. Then, when your child has finished it and wants more, offer another pour, but wait for that communication before you provide it.

The people who treated me that way were generally bullies taunting me after taking something that belonged to me. The child is thirsty. They want to be loved. The parent is treating them like a water-restricted rat in a Skinner box, for reasons that might never seem to make sense. The least effective parenting method is “because I said so.” If you can’t give a coherent explanation for what you’re demanding, why are you demanding it? The child is right to be skeptical, and it’s confusing that the parents would behave irrationally, and thus unpredictably. Raw exercise of power isn’t the right model for how to treat loved ones.

Finally, consider these passages from bell hooks’s All About Love in this context:

And it is especially hard to speak of love when what we say calls attention to the fact that lovelessness is more common than love, that many of us are not sure what we mean when we talk about love or how to express love.
Everyone assumes that we will know how to love instinctively.  Despite overwhelming evidence to the contrary, we still accept that the family is the primary school for love.  Those of us who do not learn how to love among family are expected to experience love in romantic relationships.  However, this love often eludes us.  And we spend a lifetime undoing the damage caused by cruelty, neglect, and all manner of lovelessness experienced in our families of origin and in relationships where we simply did not know what to do.

Only love can heal the wounds of the past.  However, the intensity of our woundedness often leads to a closing of the heart, making it impossible for us to give or receive the love that is given to us.
An overwhelming majority of us come from dysfunctional families in which we were taught we were not okay, where we were shamed, verbally and/or physically abused, and emotionally neglected even as we were also taught to believe that we were loved.  For most folks it is just too threatening to embrace a definition of love that would no longer enable us to see love as present in our families.  Too many of us need to cling to a notion of love that either makes abuse acceptable or at least makes it seem that whatever happened was not that bad.
On any given day in my family of origin I might have been given caring attention wherein my being a smart girl was affirmed and encouraged.  Then, hours later, I would be told that it was precisely because I thought I was so smart that I was likely to go crazy and be put in a mental institution where no one would visit me.
Years of therapy and critical reflection enabled me to accept that there is no stigma attached to acknowledging a lack of love in one’s primary relationships.  And if one’s goal is self-recovery, to be well in one’s soul, honestly and realistically confronting lovelessness is part of the healing process.  A lack of sustained love does not mean the absence of care, affection, or pleasure.  In fact, my long-term romantic relationships, like the bonds in my family, have been so full of care that it would be quite easy to overlook the ongoing emotional dysfunction.
The notion that love is about getting what one wants, whether it’s a hug or a new sweater or a trip to Disneyland, is a way of thinking that makes it difficult for children to acquire a deeper emotional understanding.
In our culture the private family dwelling is the one institutionalized sphere of power that can easily be autocratic and fascistic.
I interrupted and suggested that he might not be the misogynist woman-hater he is today if he had not been brutally beaten by a woman as a child….Yet they could not acknowledge that it was wrong for an adult to hurt a child in this way.