Thursday, April 5, 2012
Misunderstanding Autism: Mistakes Have Consequences
The web site http://newautismtherapy.com is interesting-- in a disturbing sort of way! The site offers a discounted (financially, I mean) self-designed home therapy that seems to be based on a variety of sensory stimulation techniques. This is an idea very common among occupational therapists, that you can design a “sensory diet” that will counteract developmental or other difficulties. The concept goes back to Condillac at the time of the French Revolution and was picked up by other historical figures like Itard, the man who worked with the “Wild Boy of Aveyron”, as well as more recent people. Of course, it’s never been shown to be effective by systematic investigation, but it’s got plenty of history behind it-- nothing “new” about it..
There are other problems associated with newautismtherapy. One is a link to a blog that shows some remarkable assumptions leading to remarkable misunderstandings. At http://newautismtherapy.com/autismblog/holding-therapy/, the writer, Tony Rowe, refers to having had a “love-hate” relationship with holding therapy, but now having tried it as an adult and thinking the outcome was good. He quotes the European holding therapist Jirina Prekop as stating that the treatment, which involves physical restraint that may be fought hard by the subject, to the point of blood and bruises, is “To hold firmly with love someone who is in deep soul crises, until he or she has cried out all the rage and sorrow and feels freer and more contented”.
In quoting Prekop, and elsewhere, Tony Rowe shows a commitment to a belief about emotion that dates back a long time, was assumed to be true by Sigmund Freud and the ethologists, but is probably incorrect. This is the idea that unexpressed emotion acts hydraulically; it does not dissipate, but builds up pressure that eventually will wreak havoc. To get rid of the pressure, according to this viewpoint, it’s necessary to cause the emotion to be fully expressed, and the expression may be far outside the context of whatever was the original cause of the feeling. “Vent” the emotion, and the person will be cured of the problem, with symptoms of the internal pressure also disappearing. Holding therapy is based on that set of beliefs. Of course, there is a little problem-- that does not appear to be the way emotion works. On the contrary, expressing emotion may intensify it rather than dissipate it. Tell off someone who has offended you, and you’re likely to feel even angrier, as if your own action has proven to you how hateful that person really is. No systematic investigation has supported the belief in catharsis, or “drainage” of negative emotions. And nobody even thinks that acting very happy would impair your experience of happiness, which it should do if expression of emotion could dissipate feelings.
Rowe’s blog runs into further trouble with http://newautismtherapy.com/autismblog/what-causes-autism/. This post suggests that autism is caused by some experience that triggers a “fight, flight, fright or freeze” reaction, resulting in an overstimulation or shutdown of some senses (see first para, above). Decades ago, people like the former art historian Bruno Bettelheim pushed the idea of a traumatic experience as the cause of autism. However, no systematic investigation of autism has revealed that this is the case, unless you include evidence about prenatal exposure to disease as showing psychological trauma. On the contrary, as you can read in the New York Times this morning (4/5/12), systematic work is showing genetic factors, including mutations, as likely causes of autism. Because thousands of different genetic events could be responsible for interference with development of communication and social interactions, this won’t be understood instantly, but the process of understanding is under way.
Rowe’s belief about the cause of autism leads rather obviously to the suggestion of holding therapy and sensory stimulation as a treatment. However, that kind of thinking is what is called the “pathophysiologic rationale” (see Howick, J. , The philosophy of evidence-based medicine: A philosophical inquiry. Blackwell-Wiley). This rationale involves thinking you know what the mechanism of a problem is, and deducing a treatment that “should” work on that basis-- but believing you can skip the work that would show the treatment is effective. Unfortunately, that’s the step that can’t be skipped, and it’s wrong factually and morally to imply that it can. Making that mistake causes families in need of help to avoid conventional treatments in favor of alternatives that should not be expected to be helpful.
When you add into this mix the newautismtherapy suggestion that you can design and implement your own autism treatment--- and that you have to buy the directions rather than finding them in a published book or journal article-- the result appears to be the makings of a good old-fashioned jug of snake oil. Don’t take it internally!