There’s a followup today to an earlier Aspergian post which argued pretty persuasively that Applied Behavior Analysis is more inhumane than dog training. This time around, Carol Millman (who has “a degree in Psychology, a diploma in animal health technology, and a diagnosis of autism” and “specializes in training assistance dogs”) takes apart—demolishes, really—a response by a pair of ABA practitioners.

I just want to make a few points, highlight a couple of things. Underlying much of Millman’s critique here is that the professional guidelines for ABA practitioners effectively and in essence make a distinction between the client and the patient. Typically, the former is the parent, caregiver, or institution, while the latter is the actual child.

In fact, the true client in these situations could be defined as society itself. Society certainly is the true subject of ABA, with the child merely the object. The treatments seeks not to make the child feel better but society feel better.

Millman notes three important, related things: “[s]omething being effective doesn’t mean that it is healthy for development or self-esteem”; studies of the effectiveness of ABA “are based on measurements of behavior, not of emotional impact of the antecedents on those behaviors”; and when it comes to ABA and that purported effectiveness “[w]hat isn’t proven is whether its goals are worth attaining, or at what cost”.

Last week, I referenced several things I’ve written before about how a study suggesting proof of autism “recovery” ignored other potential, and obvious, explanations for the results; how “evidence-based therapy” depends entirely upon what one is defining as success; and how studies are beginning to show that there’s only “weak evidence” that ABA works even on its own terms.

Here’s my concern as a late-diagnosed autistic adult who therefore didn’t undergo ABA as a child: there’s comparatively so little research into autistic adulthood, let alone midlife, that I fear the only exposure to autism doctors, therapists, and social service agencies will have is the argument that treatment is about modifying the behavior of the autistic.

My concern—and I guess I’ve written about this before—is that the prevailing ABA-centric worldview of childhood autism treatment impacts not just those children, but the rest of us, too.

When I search for therapists or counselors who deal with autistic people, I pretty much assume that anyone who emphasizes “social skills” or “coping skills” is focused on helping autistic people mask better, not, say, helping them know how to recognize when their limits might be approaching.

When your views of treatment codify and prefer the desires and demands of society rather than the patient—when you de facto treat the patient merely as an object through which you advance your real subject’s (society) goals—“you aren’t engaged in psychology or social work,” as I wrote earlier this year, “you instead are engaged in a form of social control”.

I’m going to include verbatim how I ended that “social control” post, because I think it sums up how I feel about the argument Millman makes in both her original post and its followup better than anything I could try to say anew.

These professions and these activities should not be thought of solely as efforts to heal and help the individual, but to heal and help the society around the individual. As much as they have the responsiblity to help the atypical learn how to move through the typical world around them as authentically and with as little self-damage and distress as possible, they also have the responsiblity to teach the typical to empathetically make more room in society for the atypical. They ought not only be private actors but also public ones.

There’s an old and semi-apocryphal aphorism that the job of a newspaper is “to comfort the afflicted and afflict the comfortable”. So, too, the job of the psychologist and the social worker, the therapist and the counselor.

If society feels that its typicalities are paramount above and beyond and despite the internal well-being of a psychological patient, that society itself has an illness which should be—must be—acknowledged, addressed, and treated by psychologists and social workers. Bending the individual patient to the will of an ill society is the opposite of “do no harm”, for all parties.

Autism Mental Health Morality Psychology

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Hello. My name is Bix. @bix