Riding the Autistic Spectrum

Where are you located on the Autistic Spectrum? Do you have the full set of the ‘triad of impairments’ (impairments in social interaction and communication, and repetitive behaviour) that used to be the main markers in fixing a diagnosis of ‘Autism’, or are you just a bit obsessional? Do you just like to live in a clean house, and do you follow routines in getting up, washing, cleaning your teeth, going to work, and so on. Be careful, someone might accuse you of being ‘autistic’.

A few years ago, the diagnosis of ‘Autism’ was made infrequently, even for children with major problems. Parents would spend years seeking an explanation for their child’s unusual behaviour until they would eventually light on a psychiatrist prepared to make the diagnosis. Clinicians are now more willing to diagnose Autism, and are helped by a number of useful diagnostic measurements, but in the meantime the diagnosis has changed into a spectrum. The idea of regarding a disorder as a spectrum rather than a diagnosis is based on the observation that most of the distinctive traits and behaviours comprising the triad of impairments do not have a clear cut-off point. In other words, people do not have either impaired communication or unimpaired communication, they have degrees of impairment. This sounds sensible, but there are problems.

In the first place, people use ‘spectrum’, but still think ‘diagnosis’. Being told someone is ‘on the Autistic Spectrum’ becomes a synonym for a diagnosis of Autism, even though the person in question does not have the severe impairments traditionally associated with the diagnosis. Over time, this problem has got worse because spectrums, by definition, do not have a clear cut-off point distinguishing when you are or are not on the spectrum. In the case of Autism, this has meant that the term is now used to designate a whole collection of behaviours that not long ago would have been regarded just as being odd or eccentric. This repeats the process that took place some years ago with the diagnosis of ‘Depression’: now everyone who feels a little miserable or unhappy says they are ‘depressed’. This wouldn’t be so bad if it was just a matter of the names people give to themselves, but names have consequences. Calling yourself ‘depressed’ rather than ‘miserable’ suggests you have a medical condition which requires medication. Calling your child ‘autistic’ rather than ‘a bit obsessional’ suggests you need expert assessment and treatment. Concerned parents thereby divert scarce professional resources from those who do actually experience severe problems in their daily lives, including those who have ‘Autism’ in the original sense of the word.

Apart from this problem, there is an unresolved puzzle with the Autistic Spectrum: what is at the other end of it? My unsystematic observations indicate that there are a group of people with significant impairments who are rarely recognised as such. There is therefore no diagnostic term to describe them, but I will call them ‘Asystemic’. Whereas people with Autism find human behaviour hard to interpret but are more confident in dealing with systems and machines, people with asystemic disorder have no problem understanding other humans, indeed they revel in their human contacts. However, they are unable to comprehend machines, including those we use in our daily lives. You can recognise asystemics when you see people failing utterly to work simple machines like a photocopier, a computer, or even a lift. It is quite common to see asystemics frantically pressing the lift call button in the belief that this will make the lift realise that their need is urgent. In other words, asystemics, lacking a ‘theory of machines’, anthropomorphise the devices they come in contact with. Are asystemics disabled? Many find refuge in jobs like psychology, social work or even politics, where their understanding of human behaviour is valued and the devastation they cause by their failure to appreciate systems will be hidden for some time. Of course, from their perspective, most of the rest of us must seem ‘autistic’, and by comparison to them, we are.