Advocating for Institutional Education?!

I want to preface this post with the general comment that the person I'm talking about in this post is actually fairly awesome when it comes to her views on autism and psychiatric disability. Especially when taken in light of her background. Nonetheless, I felt our interaction illustrated some common autism stereotypes in a rather interesting way.

Today my college hosted representatives from our graduate program to speak to undergraduate students about their programs, admittance, etc... There was a representative from Experimental, Industrial/Organisational, and Clinical. Being an undergraduate student hoping to get into grad school and also having helped set up the event, I was there. After the short introductions, of course, people were given the opportunity to ask questions.

After the event I approached the representative from the clinical program and asked her some questions pertaining to the medical model of disability and the interactionist model of disability. I got some good answers but I felt that she didn't really understand my question. Communication barrier, that's okay. What's important is the attitudes behind the language rather than whether or not a person can speak the same jargon as I can.

So I decided to apply the question in a very specific case and I proceeded to give her a kind of case study of an autistic 14 year old who's failing to make eye contact and engaging in stimming behaviour, asking her opinion on what she would do. Turns out, I got what I would consider a very positive response: She told me she would consider whether or not the behaviours were harmful to the child such as self-harm stims and then work from there to determine what function the stims served such as relaxation, communication, ect... but that she wouldn't consider such a behaviour in and of itself a problem. The stim was a tool to help the client rather than a pathology. Which is good, it's what I wanted to hear. (Yay!)

This, of course, got us talking about applied behavioural analysis, because how can you talk about stimming and clinical psychology without talking about ABA. Naturally, I criticised ABA and we got into a lively debate, which was good.

What got me was when she criticised me for taking the side of the educational industry.

To her, she assumed that I was criticising ABA from the grounds that it was too expensive and therefore a problem for limited special educational budgets. I of course told her that, no, I was not arguing against ABA because of an economic, or any other, practical stance, but that I was advocating as an autistic adult questioning the actual clinical value and ethics of the treatment.

It's nothing overt and it's certainly nothing that speaks to the representative's character or attitudes towards autistic people. But it does make a point, I feel, about the inclusion of autistic people in the discussion regarding our own care that someone would automatically jump to the conclusion that I'm arguing from a non-autistic perspective.

Of course, it very likely was just due to recency effects or any other number of factors that could have primed her to think about economics and the educational industry. It, of course, wouldn't surprise me if it was just because the self-advocacy perspective is so drowned out by other special interests in our current medical culture. Nonetheless, it's something to think about.

All of that being said: From what I have seen of the graduate clinical program at SJSU I would be very seriously considering it if my professional emphasis was more in line with the clinical bent of the degree. As it is, I'm much more interested in community organisation such as designing and operating harm-reduction programs than working as a clinical psychologist.

DSM V Proposed Revisions: Initial Reactions

The DSM V Proposed Revisions came out this morning which means that us, the general public, are finally able to get a little bit of transparency to what has been a traditionally very secretive process. I went and had a look this morning and, baring my commentary on the secrecy of the DSM V development process, I thought I would share some of my first impressions with some of the diagnoses that I find particularly close to home:

First, Transvestic Fetishism:

* Still requires the individual to be male. Still a hold-back from the DSM IV reinforcing the double standard of acceptable gender bending behaviour.

* Requires "significant distress or impairment." I suppose this is good in that it does not pathologize normal, healthy, nondistressing play. On the other hand, it reminds me of certain "reparative therapy" doctrines which hold that they do not treat homosexuality, per se, but "unwanted homosexuality." Ergo, the DSM V criteria pathologize the behaviour itself rather than stressing that the disorder lies in the discomfort.

* Here's a gem: specifiers towards whether the behaviour is fetishistic (towards the clothing) or from autogynephilia. TS Roadmap for more information regarding autogynephilia and why it is problematic.

Second, Sexual Interest/Arousal Disorder in Women and the same only in men.

* Homosexuality isn't a psychiatric disorder but apparently asexuality is.

Paraphilic Coercive Disorder. If you get off on fantasies of raping people you are psychiatrically disordered but only if:

* You are upset about said sexual urges. or...

* You have raped at least three people. (Rape one or two people, apparently it's okay)

* Also of note: as a DSM V diagnosis, what implications would this have in regards to the ADA. Would sexually motivated rapists be protected by the ADA?

Tourette's Disoder criteria was an improvement:

* Removed the criteria for maximum tic-free period. Tourette's waxes and wanes, this fix is good.

* However, criteria still require onset to be below age 18, which is completely arbitrary and for no real reason other than statistical observation. News flash: there are a lot of Tic Disorder NOS people out there who match a TS diagnosis perfectly except for age of onset.

Gender Incongruance (formerly GID) in Adolescents and Adults:

* Finally, "disorder" is not part of the name.

* Finally, in the eyes of psychiatry, you can be transgender without being gender binary. WIN!

* Finally, you can unquestionably be classified as transgender just by asserting your transgender feelings or stating your wish to transition.

* Not so great: some of the language ("other gender") fails to recognise transgender peoples' actual gender.

* Fail: it's still listed alongside the sexual disorders.

Gender Incongruance in Children:

* Criteria now state that the child absolutely must express a conviction that they are a member of the opposite sex.

* Not so great: Requires transgender children to be gender typical in regards to their target gender.

* Does not recognise nonbinary genders, which is odd given that the adolescent/adult version does.

Asperger's Disorder: It's being eliminated and being merged with vanilla autism.

* Win in terms of recognition that Asperger's is "real autism."

Dissociative Identity Disorder:

* Possible addition of "significant distress or impairment" clause. Cool!

I haven't had a chance to read all of the proposed revisions, just some of the ones I'm particularly interested in. I'll probably write more in depth about some of these changes on a later date or add to this as I read more of the draft DSM V. In the mean time, enjoy!

Edit: My previous claim that the DSM IV diagnosis of mental retardation will still be called "mental retardation" was due to my misreading of the proposed revisions. It was a mistake and has been removed.

Picoult: Irony in Prejudice

I've been following some of the buzz surrounding Jody Picoult's new book House Rules over at Cat in a Dog's World. Interesting, but unfortunately more of the same regarding how disabled people are treated in mainstream, abled, discourse. Her analysis of a discussion question for the book, however, caught my attention.

The question:

Do you know anyone with Asperger's syndrome? Did the descriptions of Jacob fit what you know of that person?

As Cat in a Dog's World already explained, the principle problem with this question is that it assumes that all Asperger's individuals are fundamentally identical, which, from a social scientific point of view, is a symptom of the fallacy of out-group homogeneity.

The idea of the cognitive miser holds that, as individuals, we have limited ability to think about the world around us and that we are simply not able to take into consideration everything around us. As cognitive misers, the theory holds, we conserve cognitive resources by creating mental shortcuts concerning the nature of the world around us, stereotypes, which allow us to predict our environment.

Additionally, those of us who spend the least amount of effort thinking about a certain aspect of our world create the most generalising, or stereotypical, cognitive shortcuts. Therefore, according to the idea of the cognitive miser, prejudice stems from an unwillingness to exert the effort to challenge our preconceptions.[1]

Anyway, I was musing on the idea that a stereotyping question in a book club which is meant to invoke critical thought could, in itself, be based on the unwillingness to think critically.

[1]Think about that in terms of privilege for a moment.