At its heart, diagnosis is about exerting control. Clinicians want to get some sense of control in understanding a problem. We link diagnosis to prognosis to control our expectations of how likely and how much we will see a change in the patient’s condition. Insurance companies want to get a handle on how much to spend on who. Schools want to control access to resources and organize their student body. And with the current healthcare situation, the government is sure to use diagnosis as a major part of the criteria in determining who gets what kind of care.
Therapists and Educators do not like to think of ourselves as controlling people. But we often inadvertently attempt to exert control over our patients and entire segments of the population, by defining something as a problem and then locating it squarely in the individual we are “helping.”
This week has been one of those weeks where I have heard from several different colleagues about workshops they are attending where the presenters are linking Asperger’s with Gaming Addiction: Not in the sense of “Many people on the Autism Spectrum find success and motivation through the use of video games,” but rather in the sense of “excessive gaming is prevalent in the autistic spectrum community.”
This has always frustrated me, for several reasons, and I decided its time to elaborate on them again:
1. Correlation does not imply Causation. Although this is basic statistics 101 stuff, therapists and educators continue to make this mistake over and over. Lots of people with Asperger’s play video games, this is true. This should not surprise us, because lots of people play video games! 97% of all adolescent boys and 94% of adolescent girls, according to the Pew Research Center. But we love to make connections, and we love the idea that we are “in the know.” I can’t tell you how many times when I worked in education and clinics I heard talk of people were “suspected” of having Asperger’s because they liked computers and did not make eye contact. Really. If a kiddo didn’t look at the teacher, and liked to spend time on the computer, a suggested diagnosis of Autism couldn’t be far behind. We like to see patterns in life, even oversimplified ones.
2. Causation often DOES imply bias. Have you ever stopped to wonder what causes “neurotypical” behavior? Or what causes heterosexuality for that matter. Probably not. We usually try to look for the causation of things we are busily pathologizing in people. We want everyone to fit within the realm of what the unspoken majority has determined as normal. Our education system is still prone to be designed like a little factory. We want to have our desks in rows, our seats assigned, and our tests standardized. So if your sensory input is a little different, or your neurology atypical, you get “helped.” Your behavior is labeled as inappropriate if it diverges, and you are taught that you do not have and need to learn social skills.
Educators, parents, therapists and partners of folks on the Austism Spectrum, please repeat this mantra 3 times:
It is not good social skills to tell someone they do not have good social skills.
By the same token, technology, and video games, are not bad or abnormal either. Don’t you see that it is this consensual attitude that there is something “off” about kids with differences or gamers or geeks that silently telegraphs to school bullies that certain kids are targets? Yet, when an adolescent has no friends and is bullied it is often considered understandable because they have “poor social skills and spend too much time on the computer.” Of course, many of the same kids are successfully socializing online through these games, and are active members of guilds where the stuff they hear daily in school is not tolerated on guild chat.
Let’s do a little experiment: How about I forbid you to go to your book discussion group, poker night, or psychoanalytic institute. Instead, you need to spend all of your time with the people at work who annoy you, gossip about you and make your life miserable. Sorry, but it is for your own good. You need to learn to get along with them, because they are a part of your real life. You can’t hide in rooms with other weirdos who like talking about things that never happened or happened a long time ago; or hide in rooms with other people that like to spend hours holding little colored pieces of cardboard, sort them, and exchange them with each other for money; or hide in rooms where people interpret dreams and talk about “the family romance.”
I’m sure you get my point. We have forgotten how little personal power human beings have before they turn 18. So even if playing video games was a sign of Asperger’s, we need to reconsider our idea that there is something “wrong” with neuro-atypical behaviors. There isn’t.
A lot of the work I have done with adults on the spectrum has been to help them debrief the trauma of the first 20 years of their lives. I’ve had several conversations where we’ve realized that they are afraid to ask me or anyone questions about how to do things, because they worried that asking the question was inappropriate or showed poor social skills. Is that really what you want our children to learn in school and in treatment? That it is not ok to ask questions? What a recipe for a life of loneliness and fear!
If you aren’t convinced, please check out this list of famous people with ASD. They include Actors (Daryl Hannah,) bankers, composers, rock stars, a royal prince and the creator of Pokemon. Not really surprising when you think about innovation.
3. Innovation is Dangerous. Innovation, like art, requires you to want things to be different than the way they are. Those are the kids that don’t like to do math “that way,” or are seen as weird. These are the “oversensitive” ones. These are the ones who spend a lot of time in fantasy, imagining a world that is different. These are the people I want to have over for hot chocolate and talk to, frankly.
But in our world, innovation is dangerous. There are unspoken social contracts that support normalcy and bureaucracy (have you been following Congress lately?) And there are hundreds of our colleagues who are “experts” in trying to get us all marching in lockstep, even if that means killing a different drummer. When people try to innovate, they are mocked, fired from their jobs, beaten up, put down and ignored. It takes a great deal of courage to innovate. The status quo is not neutral, it actively tries to grind those who are different down.
People who are fans of technology, nowadays that means internet and computing, have always been suspect, and treated as different or out of touch with reality. They spend “too much time on the computer,” we think, until they discover the next cool thing, or crack a code that will help fight HIV. Only after society sees the value of what they did do they get any slack.
Stop counting the hours your kid is playing video games and start asking them what they are playing and what they like about it. Stop focusing exclusively on the “poor social skills” of the vulnerable kids and start paying attention to bullies, whether they be playground bullies or experts. Stop worrying about what causes autism and start worrying about how to make the world a better place for people with it.
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