Unmapping The DSM To Remap Autism

The other day I sat down and listened to an interview with Jonathan Green in part about his paper on neurodiversity which along with earlier ones on autism as “emergent and transactional” apparently yielded some Twitter response about eugenics.

What struck me the most in the interview itself is this bit which made me prick up my ears for reasons any regular readers of mine will spot pretty much right away.

I think what I’d be saying—and this is where I think the phenomenology is important—is that we actually think from the phenomenology work that we’ve done that the core neurodivergent phenotype may lie slightly behind what the behavioral phenotype currently tells us. So that if you listen to autistic people and their experience, actually, their experience doesn’t really map onto the DSM category.

You know, their experience is of an overwhelming world, a huge sensitivity—which often has great benefits as well as difficulties associated with it—[and] an attentional style which is highly focused at times, and then feels pretty chaotic at other times—but again, has some very powerful strengths to it. […] These people can tell us what it feels like to be autistic, and what they tell us doesn’t map onto DSM very well.

I’ve talked a lot here about how while I think there’s an autistic pathology I also think we fundamentally get it wrong.

My experience of being autistic suggests that the underlying issue is an atypical susceptibility to becoming overwhelmed by stimuli, and that many if not most of the things we pathologize about autism in fact are the adaptations developed by the autistic brain to accommodate, mitigate, and navigate that impairment, and we stigmatize and pathologize those adaptations at our peril.

That’s basically reflected in the position Green takes in the above excerpt from the interview, although it doesn’t necessarily mean we land in the same place as to what, if anything, to do about it all.

Now, it’s not entirely clear to me what sort of “early pre-emptive interventions” Green references in his paper because he mostly makes use of terms of art without any sort of obvious lay interpretation.

It’s important that he talks about “environmental experience” and “the distinctive experience of the autistic sensorium from early life, and the early experience of being overwhelmed by experiences or misunderstood by others”, but I make no judgments here as to what he says to do in the early life of an autistic.

I will say that if the following description from Andrew Whitehouse’s responding commentary is an accurate reflection of Green’s position, I’ve some quibbles.

Individual brain differences early in life (most often with a genetic origin) lead to the emergent clinical autism phenotype, driven by the developmental transaction between these brain differences and the child’s experience of the world. As Green indicates, that autistic behaviours are emergent over the early years of life is a straightforward point to make. However, Green’s argument, when stripped back to its core elements, is a true evolution in thinking. Using the plainest language possible, Green’s argument is that many autistic children are not born destined to develop clinical autism; that is, they are not born ‘autistic’. Rather, children are born neurodivergent, with an autism phenotype emerging out of the interplay between biology and environment in early life.

There’s an element here of the social, or at least social-relational model of disability here, but there’s also the clear suggestion that a person’s autistic tendencies can be kept “sub-clinical” purely through some form of early interventions.

I’m extraordinarily skeptical of the idea that any early intervention somehow will inoculate a person from future mismatches between their innate neurodivergence and the environment in which it must by normative social and capitalist necessity operate. Those mismatches are inevitable, barring positive societal upheaval, and it’s not clear from what I’ve read of either Green or Whitehouse how, exactly, a purported “sub-clinical” autism wouldn’t simply erupt later into clinical autism.

Again, since my position is that the “clinical” signs of autism in fact are the valiant attempts at the autistic brain to accommodate, mitigate, and navigate the actual clinical aspect—the susceptibility to overwhelm—the only true measure of whether autism is “sub-clinical” is the degree in reduction of overwhelm, not the degree in reduction of the adaptive behaviors.

It’s clear from the interview that Green in some degree shares my understanding that the autistic experience is one in which the clinical pathology doesn’t map to the DSM’s, but it’s not clear (to me, anyway) from the interview or the paper what Green thinks this means for dealing with autism and autistic people.

It would be one thing if the goal were to lesson the damaging environmental impact upon an autistic child in order to give them an upbringing that comports as much as possible with their neurodivergence, allowing them to grow up in a reasonably stable manner until they are old enough to have a growing degree of agency that allows them to make further decisions on their own.

At least by Whitehouse’s account, however, that doesn’t appear to be what we’re talking about here, and I fully admit that we’ve reached the limits of my lay understanding of what it is, precisely, that Green says we should be doing by way of “early pre-emptive interventions”.

Certainly, that “pre-emptive” could be doing a lot of troubling eliding work here.

This idea that the autistic experience as reported by autistic people might have some disconnect with the pathologies of the DSM also beings me back to the idea of monotropism, because I’ve reconsidered my own view of its role somewhat.

Rather than monotropism being the underlying autistic state, I think in fact monotropism effectively is a description of what I’ve called the adaptive strategies developed by the autistic brain to accommodate, mitigate, and navigate the actual underlying impairment.

As something of a side note, I’ll also mention that I realized recently that my description of the “autistic local cache” for all intents and purposes is a description of Spline Theory—itself the result of an easily-overwhelmed brain that tries to survive through monotropism.

What’s more, what I’ve termed the “uncollapsed autistic wave function” in effect is a description of the monotropic adaptation failing in a real-world environment and in real time.

All of this experientially underscores for me that encountering a mismatch between my neurodivergence and the demands of the world which it must inhabit is an inevitability, and always was an inevitability.

Green’s position, per Whitehouse, appears to be that neurodivergence is present at birth but (“clinical”) autism develops only through interaction with the environment.

If the neurodivergence in question is that atypical susceptibility to overwhelm, and the “clinical” autism are those adaptive behaviors we’ve mistakenly pathologized, I’m going to need someone to explain to me in lay language exactly what kind of early intervention Green thinks can forever fend off the mismatch in the future.