High Functioning Autism (Including “Asperger’s Syndrome”), Memory, and Time

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Time

Time (Photo credit: Moyan_Brenn)

Do you have some memories that are so vivid that they are like three-dimensional realities re-playing in your mind? I think most people have some memories like that–a death in the family, a romantic breakup, one’s wedding day–but what if your collection of such memories was larger than just a few? What if, even if you lacked a photograpic memories of everything, had entire groups of memories dating back twenty or more years that could re-play so intensely that it feels as if they fill your heart to bursting? For many people with High Functioning Autism Spectrum Disorder (including what in DSM-IV was called “Asperger’s Syndrome), time flows differently from most people who do not have autism. More memories are preserved intact than are found in so-called “neurotypical” people, and when they are remembered they are so real that one feels as if he were participating in reality once more.

I noticed this at my thirtieth high school reunion in 2010. Although people generally remembered one another (and they remembered me and I them), they lacked vivid memories of high school. But for me, although I had forgotten most days, I remembered much more concrete detail and many more events that most of my fellow class members. Most were not memories of earthshaking events that number in the hundreds. Some examples: Walking down the hall looking at the class photos from the 1950s and early 1960s, thinking myself part of a larger tradition at my high school and wondering about the days my aunt and mother went there. Playing chess in the cafeteria at lunch and some of the conversations and insults players hurled at each other. Feeling overwhelmed at the end of a semester and talking to a fellow student about it–he signed my annual that day and wrote, “Keep studying and you’ll make it.” I’ll not bore you with more examples–the point is that no one else had that many vivid memories of high school. One student remembered arguing with me in history class but did not remember another student who argued with her constantly. To me, that was amazing, and it was other people who were different, not I who was.

Does time and memory function differently for the (high functioning) autistic person? Why are my memories (and the memories of other students I know who had Asperger’s traits) so vivid that one re-lives them as if they were the present moment? A student from another local school from chess tournaments with Asperger’s traits talked to me about twenty-five years after a tournament and remembered the specific game we played including the opening and the moves! Such vivid memories are a gift–and a curse. Memories of times I was bad come back to the point that I feel guilty as h..l over things I did when I was a small child. Memories of swinging on a tree swing at Granddaddy and Granny’s are so powerful that I feel like I am there and am heartbroken when I realize that I am not. I have heard other HF autistic people say similar things. Time, to us, seems compressed, with thirty years in the past at times seeming like the present. We certainly do not experience time as God does, an eternal present, but it may the closest someone gets to that on earth. Sometimes memories, even the good ones, hurt so much that I shut them out. Each good event that is in the past seems like a little death that I want resurrected–I wonder if others with HF autism have had the same experience–reply to this post if you have and/or if you think this is an autistic trait. It seems like autism itself–wonderful and terrible, a blessing and a curse, God’s gift and God’s scourge–and something I would not want to live without.

Borderline Personality Disorder

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Borderline Personality Disorder Awareness

Borderline Personality Disorder is a disorder I have been blessed not to have, though I’ve known individuals, some close to me, who were borderline. BPD is essentially a problem of emotional control. Borderline people have wild mood swings, though they are not usually bipolar. They can love you and think you are the most wonderful person in the world one moment, then turn on you, demonize you, and hate you. Those shifts can be unpredictable and can happen quickly, leaving family members hurt and wondering how to react. Borderline individuals tend to put people they know into lose-lose situations. If the borderline person is angry with you, whatever you say will be the wrong thing. You will, as one bestselling book on BPD alludes to, be “walking on eggshells.”

Borderline people can be manipulative, just like narcissists, but unlike sociopaths or psychopaths, they do have a conscience and are capable of love. Often, however, their love is twisted, oriented more to feeding their egos (like narcissists receiving “supply”) than truly focusing on the other person. They are good at making themselves look “too good to be true,” seeming to be interesting in everything you are. Some borderline individuals will lie about their accomplishments in order to impress others; other borderline individuals find it difficult to tell the difference between appearance and reality. The latter group can go into a dissociative state and not remember what they did during that state. If you quote the borderline’s statements to you to his family and friends, often they will stare at you as if you are crazy–because the BPD person told you that something happened that, in truth, did not happen.

BPD individuals, like narcissists, psychopaths, and sociopaths, often have a great deal of charm, which they use to their advantage. But the advantage is only temporary as people pick up on the fact that the BPD person “ain’t quite right” as we say in the South. Instability in jobs and instability in relationships may lead to the BPD going through multiple jobs quickly, moving many times, and going through multiple marriages. All relationships are unstable. The borderline person is afraid to lose anyone in his life, yet does not realize that his behavior drives people away. Sadly, the BPD individual is usually miserable inside and lonely, desperately wanting a friend. Most BPD persons do not recognize that their behaviors drive away other people; others may recognize that fact, but believe that their traits are essential for their emotional survival. That points to the greatest problem borderline individuals have in overcoming their disorder: a failure to take responsibility.

So many mental problems are due, in part, to someone believing they are the slave of fate, that given one’s background, one cannot help the way he is. For that reason, he refuses to take responsibility for his actions and blames others for bad things that happen to him. The most difficult obstacle psychologists and psychiatrists have dealing with borderline people is the borderline’s refusal to take responsibility. The borderline often tries to manipulate the therapist. Sadly, many affairs with therapists occur that way. One psychologist told me that of his fellow therapists who fell into affairs, probably over 95% of the lovers were borderline individuals. Since flirtation gains the borderline attention and helps with low self esteem (which only masquerades as high self esteem), many borderlines are extremely flirtatious. Not all will go to the point of a full-fledged affair, but many do.

BPD usually has its origins in childhood. Oftentimes, childhood sexual abuse by a parent or stepparent is the cause–though this is not the only cause. BPD usually manifests in a person’s teens. Some borderline individuals spontaneously recover in their forties; others never recover. Therapy is notoriously ineffective, although newer cognitive methods work better than previous therapies. It is a joke among psychologists that the way to harm an enemy psychologist is to refer a borderline patient to him. If the psychologist can get the borderline person to admit that he is not the slave of forces beyond his control and that he is able to change, the major step toward recovery has occurred.

Are borderline individuals sick or evil? Some borderline behavior seems to be evil: the lying, the manipulation, the willingness to say or do almost anything to get what one wants, the sudden turns toward absolute hatred. I know of one therapist (not my therapist) and one person who works in the criminal justice system who consider borderline people to be evil. In my opinion, most of them do not begin as evil, though, like any human being, they may become evil due to habituation. They are trying to survive something that hurt them so much as a child that they believe that their behaviors are the only way they can survive in the world. They may believe that if they did not behave the way they do that they would fall apart–indeed, their personalities seem to be fragmented. These sad, frightened people need to be guided toward healing–but they must be willing to get help and be serious about it. To anyone who may have this disorder: I pray for them to get help, to engage in positive behaviors that support solid relationships with others, and to find peace in their lives.

Aspergers and Taking Responsibility: A Two-Way Street

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Aspergers Bag

Image by TheTherapist via Flickr

As I have mentioned in previous posts, about five years ago I was diagnosed with Asperger Syndrome, a mild form of autism. I think it is probably closer, at least in me, to a variation on normal, but there are certain personality traits that I have that characterize Aspergers–focusing on one or two interests to the exclusion of others, failure to understand small talk, failure to understand the nuances of human communication, saying exactly what one thinks regardless of the social propriety. The ultimate problem is a failure to understand adequately other minds. But the diagnosis should not be used as an excuse for social impropriety. There are times I have been rude, not realizing that I was rude, because of my habit of saying exactly what I think, and to my surprise, the party whom I addressed was offended. But I, like all human beings who are not prevented by drugs or certain illnesses, have free will–whether I have Aspergers or not, I, like all people, have a moral responsibility to be tactful and to avoid being rude–and the proper reaction when someone is hurt by my actions is to apologize for being rude. The reason I have been open about Aspergers is not to make excuses for the times I have behaved in a rude fashion, but to encourage those who have known me over the years or who remember me from the past to understand me better. Those of us who are Aspies also should learn enough social graces to get by in the world–we do have to find jobs, and hopefully get married and have families. Many of us teach, and that means learning how to interact with students, faculty, and staff.

There are some personality traits that I find practically impossible to change. I do not not like small talk, but I have learned the mechanical rules of small talk enough to get by in most settings–at least for a short period of time. And although I, like many other Aspies, enjoy certain intellectual pursuits, not all people enjoy those pursuits as much as we do, and they may not be as interested in hearing all about our particular interests. Even though we do not mean to come across as full of ourselves, we do.

I have never liked the term “neurotypical” as used by some advocates of Austistic and Aspergers people. I know those who originated the term are trying to avoid Aspergers being considered a disease rather than as a variation of normal. But some people think that we are trying to set ourselves apart from other people as a special class due special privileges, even though that may not be the case at all.

While those of us with Aspergers should not make excuses, this does not excuse those who make fun of our diagnosis or who are cruel. It is human nature to fear that which is different, and sometimes the toughest looking people are those who are the most afraid–at least in my experience. I attend many chess tournaments, and although most chess players are not Aspergers, I have seen several who are. I can understand why they might be off putting to someone who is “normal.” I am sympathetic to the child who constantly talks about Dungeons & Dragons figurines when he is not playing chess, or to the child who is so fascinated by astronomy that it is all he talks about. Sadly, there are people in the world, both children and adults, who are not sympathetic. They demand of people that they should meet their expectations of “proper” behavior about matters that should be matters of indifference. We do have feelings, and the lack of acceptance hurts. If we do our part to function better, to learn some small talk, some social graces, and some tact, others should do their part to realize that just because we are different does not mean that we are bad people, it does not mean we are frightening or threatening in any way. It just means that we are different on matters that, unlike morality, do not make much difference in the long run. We can be too serious, but most of us have a quirky sense of humor. Many of us are successful in our chosen fields. Some of us have a lonely existence. We can get by for a few minutes in a social setting, but we often feel more comfortable at a party, say, standing off to one side by ourselves. We probably should mix more with the crowd and make an attempt to talk, but it is quite difficult–I have difficulty even in academic settings, my own field–in a party of people from many professions it is extremely difficult to gather the courage to walk up to a group of people and talk.

Hopefully most people will strive to understand those Austistic and Aspergers people they encounter, and hopefully we Aspies can do our part to bridge the gap.

People’s Reactions to Aspies

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Hans Asperger

Image via Wikipedia

More often than not I overhear a conversation among young people in which someone says, “Did you see that weird guy over there?”

“Yeah, I took a picture of him. Lookin’ down at the floor all the time, not lookin’ you in the eye, talkin’ to himself.”

“What a creep!”

When I hear this, my first reaction is that my view that American young people are among the least accepting of difference and the most conformist of all groups in American society. They are fed an ideological-based view of multiculturalism in school and university that has little to do with the actual diversity of real, concrete human beings living in the real world. Despite being taught to be non judgmental (which is dead wrong, for judging certain acts to be wrong is part of our common humanity), they become judgment in a nasty way. They look down on those people who behave differently, those who do not understand social norms–people who may not look them in the eye when speaking, people who look at the ground, people who may talk to themselves from time to time. I would bet, being an Aspie myself, that many of these individuals have Asperger’s Syndrome (what the new edition of DSM, it is rumored, will refer to as “mild autism;” the photo on the right is of Hans Asperger). I will not claim to be “holier than thou” on how I have treated people–like every person, I have said hateful and hurtful things to people. Mea maxima culpa, first of all. But I do have some advice to those people, especially teenagers and traditional-age college students who seem to identify difference with evil, and some advice to those persons with Asperger’s Syndrome, since some of our behaviors do tend to “put people off.” I also note some of my own experiences with people in my past who failed to understand my “odd” behavior.

1. If you label someone a “creep” who behaves in a way you consider to be strange, remember that you do not know that individual personally. Suppose that person is an Aspie. He may be a good moral person and a kind person, but a person who has difficulty relating to people, especially strangers, in public. That is true of many Aspies individuals. And if you say, “He should have worked on his social skills,” my answer is, “How do you know he has not.” For some Aspies, it is difficult enough to go out in public, much less to train themselves to deal with social norms with strangers. Perhaps he has worked to improve his social skills with family members and friends, but has not gotten to the point that he can relate well to strangers. Perhaps, no matter how hard he tries, he will never pick up the proper social skills to relate to strangers. Does that make him a “creep”? One day you may have an accident that makes you behave differently or appear differently than so-called “normal people.” Imagine how you would want to be treated in that situation. Then apply that lesson to dealing with Aspies and other people who are “different.”

2. When I was in high school I pulled up to the drive through window at a fast food restaurant. When I drove up to the pay booth, the woman told me the price–I fumbled around to find the correct change and muttered to myself, “I guess I find the exact amount here somewhere.” The woman opened her mouth wide and looked at me as if I were insane. Besides being unprofessional to a customer, it was cruel, and it hurt deeply. Some Aspies talk to themselves because it helps to calm them and helps them to think through the issues and events of the day. Sometimes I will talk to myself because I am thinking of ideas for an academic paper or for a creative story or poem. Remember that just because a person talks to himself, this does not imply that he is talking about you or insulting you. I can understand why seeing someone talking to himself can make you nervous; it even makes me nervous! But I try my best not to judge the person’s character or sanity because I realize my own habits. And I have worked on it–I talk to myself less than in the past–but often I slip. I am sure this is the case with other Aspies.

3. Now some advice to people with Asperger’s Syndrome. Aspies have particular areas with which they are fascinated, and they love to talk about their eccentricities. This is something they should work on avoiding since this tends to bore people or make them nervous. But it is easy to slip. One of my fascinations is collecting skulls of various animals. One bit of advice if you share this fascination: Do not talk about that interest if you have met someone for the first time. I made that mistake and the woman thought I was a freak who was interested in bones for some nefarious reason. When I heard her reaction (second-hand) I was in tears. Later, I heard than when someone explained to her that I was an Aspie, she then understood and no longer felt threatened by me. But of course I am wary of her now. Perhaps if I had approached her differently, we could have been friends. Now that is not possible–and I admit I will not open the door, even though that may be unfair and unchristian. Aspies, take note–if you have an odd interest, find some other Aspie that shares that interest online or in person–then you can talk your heart out about it. For you who are not Aspies, try to understand that those of us who are Aspies have difficulty in not steering the conversation  to our special interests. Kindly change the subject and avoid being rude.

4. Aspies, do not say the first thing on your mind to a friend without thinking about it first–you may, like me, have problems with being tactful. If you send a personal e-mail to a friend, re-read it several times. Aspies tend to be literal about relationships and oftentimes they lack tact. I have been in more than one situation in which I lacked tact in e-mails (without even realizing it), and then I was surprised at my friend’s defensive reaction. This is good advice for everyone, not just for Aspies. If you are a friend to someone with Asperger’s Syndrome, be patient and forgive–your friend will be loyal to a fault, but will sometimes say what he thinks without realizing that what he said hurt you. Point out why you are offended–then forgive–not seven times, as Jesus said, “but seventy times seven,” that is, without limit.

5. Although not all differences are good (a serial killer is “different” but is also evil in his difference), the fact that people have different personalities makes the world more interesting. Instead of calling the odd looking person who won’t look you in the eye and who talks about trains or physics or whatever his special interest is (or interests are), be friendly and talk to the individual. You may find a friend for life.

The Boundary Between Mental Illness and Evil

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"Satan Sowing Seeds" by Felicien Rop...

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Was Jared Lee Loughner, who allegedly murdered six people in Tuscon and wounded 13 others, including Congressman Gabrielle Giffords, insane or evil or both? Leonard Pitts and other columnists and bloggers have openly wondered whether “evil” is a more appropriate description of Mr. Loughner than “insane.” Psychiatry and psychology tend to medicalize deviances in human behavior, sometimes to the point that they tone down the role of human responsibility. For example, classifying alcoholism as a disease alleviates the moral responsibility a person may have for engaging in the heavy drinking that made him dependent on alcohol.  Classifying mass murderers as “psychopaths” may be accurate as a descriptive label for their condition (no empathy, no conscience), but such classification does not address the issue of whether psychopaths are evil. There are several bad arguments that someone who medicalizes terrible human actions may use. For example:

1. If person x has a mental illness, and that mental illness contributes to x’s destructive behavior, then x is not morally responsible for x’s actions.

2. Person x has a mental illness.

3. That mental illness contributes to x’s destructive behavior.

4. Therefore, x is not morally responsible for x’s actions.

The weakness of this argument is premise 1. Just because a person is mentally ill, and that mental illness causally contributes to his behavior, does not imply that the person is not morally responsible for his actions. The reason is that the mental illness may be a necessary but not sufficient condition for x’s destructive behavior. X’s evil moral character may still play a causal role as well. Or x’s evil moral character may have causally contributed to his mental illness.

Another bad argument goes as follows:

1. Deviations from normal brain structure are correlated with psychopathy and other personality disorders.

2. If deviations from normal brain structure are correlated with psychopathy and other personality disorders, then the individual with such deviations is not morally responsible for his actions.

3. Psychopathic [mass murderer, swindler–take you pick of crime) individual x has deviations from normal brain structure.

4. Therefore psychopathic individual x is not responsible for actions that are due to his psychopathy.

One problem with this argument is that correlation is not causation. Even if a causal relation could be established, this does not answer the question of which direction the causation goes (the “chicken-egg problem”). Do the deviations from normal brain structure cause psychopathy or does psychopathic behavior cause deviations from normal brain structure? Unless one accepts reductive or eliminative materialism, then one cannot automatically claim that a twisted mind and behavior are caused by an abnormal brain. To make such a claim would be to beg the question on the complex metaphysical issues surrounding the mind-body problem.

I do not know where the exact boundary between evil and mental illness. A rough answer that seems reasonable to me is that if a person’s mind is utterly divorced from reality, then he is not as responsible for his actions as someone who has a firm or even partial grip on reality. Where should that line be drawn? This is the difficulty. It seems to me that psychopaths are evil people. Borderline personality disorder is (and I’m not trying to be “facile”) is a borderline case–but if a person suffering from borderline personality disorder destroys another person’s life, emotional health, and/or reputation due to manipulation and lies, then the person seems as much evil as having a medical disorder. The refusal of many borderlines to get help or take responsibility for their actions are basic elements of an evil character. Munchausen’s Syndrome and Munchausen’s by Proxy fall in the same category–the drive for attention is twisted to the point of doing evil and manipulative actions. I know that many professional psychologists and psychiatrists would disagree. But they do not know everything any more than I as a philosopher know everything. I know there is a level of mental illness that totally removes a person’s moral responsibility for heinous actions.  But since evil is by nature a distortion of the personality, there may be some individuals who are considered to be mentally ill but who are actually evil, or some individuals who suffer from mental illness and have an evil character.  Human beings are a mixture of good and evil, and that battle, as Alexander Solzhenitsyn said, is fought in every human heart.

The Ethics of Psychedelic Research on Human Subjects

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Stanislav Grof, psychologist and psychiatrist

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Is it morally right to do research using psychedelic drugs such as mescaline, LSD, or DMT using human subjects? Much laboratory research has been done using animals already, and someone may argue that there is no need to study these dangerous substances in human beings. I will argue otherwise.

All three of these drugs, as well as other psychedelics, are widely abused–and that is one of the dangers of research–the press will find out about the research, disseminate information about it, and some non-addicts will read about the research and say, “Now that drug seems interesting–I think I’ll try it.” Ergo, we have more addicts than ever. But I would argue that that danger is exaggerated. Knowledge of mescaline and LSD has been public for many years, and DMT has become increasingly known since the 1990s. Mushrooms have been used for centuries, and ketamine has been widely abused since the 1960s. I do not see how human trials could publicize these drugs any more than they already have been–and even if they do, dangerous side effects and bad trips will also be publicized, scaring many people away from trying them.

The main reason I support psychedelic research with select groups of human subjects is that some mental illness is intractable to current treatments. Some cases of schizophrenia, for example, are so severe that current therapy does little or no good. Some researchers, such as Stanislav Grof, have used LSD in the treatment of schizophrenics. Other conditions, such as depression, can be so severe that only electroconvulsive therapy does any good, and the good that is does is only temporary. Plus, ECT carries with it the risk of brain damage. If some psychedelics could be used to treat these intractable cases of schizophrenia and depression more effectively than current treatments, especially if such research is backed up by animal studies, why not try it using select subjects. Now for subjects able to give informed consent, they should be thoroughly warned about the risks of such studies. For subjects who are mentally incompetent, the family member or person with power of attorney should be given sufficient information to give or withhold informed consent based on his interpretation of the patient’s prior wishes. If risks are thoroughly explained, and the patient has not been helped by any other treatment, and informed consent is given, I see no ethical problem with attempting to determine whether a psychedelic drug can help the patient. A critic may reply, “What about the risk of harm, both physical and psychological? What about the risk of future addiction caused by the study?” If current treatments, such as ECT, can harm the patient and only give a temporary reprieve from the illness, a study using psychedlics most likely would not do more harm than prior treatments–and it may help. As far as the risk of addiction, that comes with the territory of any drug that helps a patient feel better. Should we stop research on painkillers because some patients become addicted to them?

The FDA has been very conservative in approving studies with psychedelics. Part of this caution is necessary to prevent harm to human subjects. And no one wants to go back to the days when the U. S. Army and CIA were secretly giving LSD to soldiers–one soldier committed suicide. The FDA has the right to leave no stone unturned–I would not want to be the FDA agent who helped pass a study that ended up harming research subjects. But sometimes regulatory agencies hear the word “psychedelic” and are afraid to support any research involving such drugs, even if they potential to treat intractable mental illness. Hopefully some balance can be found between the absolute necessity of protecting research subjects and the desire to find new drugs to help those who cannot be helped with current therapies.

Is Asperger Syndrome a Real Condition?

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Hans Asperger

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In 2006 I was diagnosed with Asperger Syndrome, a condition, first identified by Hans Asperger, on the autism spectrum in which social awkwardness, a focus on particular interests to the exclusion of others, and physical clumsiness are combined. But does the term “Asperger Syndrome” refer to a real phenomenon in humans or is it a product of the modern tendency to attach labels to normal variations in personality?

My short answer is “Yes, Asperger Syndrome” is a real set of behavior patterns in some individuals”–but there is more to be said. It is true that Americans, especially, love to label. They love to medicalize. Although Attention Deficit Hyperactivity Disorder is a real condition that truly handicaps some children, there is a temptation to apply the label to children being children, especially by tired teachers or by parents looking for an excuse for their child’s poor behavior. But misdiagnosis does not imply that ADHD is a myth; it means that diagnosis must be done with care and conditions such as ADHD must be carefully defined. Otherwise, some children may be placed on Ritalin or some other drug of which we know very little about long-term effects.

Now Asperger Syndrome can be socially damaging since individuals with Asperger’s do not read other people well. Thus there are some negative effects of the condition that have practical consequences, especially for social relationships, friendships, marriage, and job interviews. There is some evidence that, like full-blown Autism, Asperger Syndrome is correlated with changes in the brain–but one must take care about such correlation. Correlation is not causation. In addition, there is the “chicken-egg” problem of whether changes in the brain affect behavior patters or whether behavior patterns remold the brain. The truth may be a combination of both. Parents with Autism or Asperger’s are more likely to have children with these conditions, so there seems to be a genetic link. A critic, however, may point out that if parents who model behavior for their children have Asperger’s, then the child may model his behavior after the parents and engage in Asperger-like behaviors. Science may not be able to answer every question about Asperger’s and heritability, but from my own experience, watching my maternal grandfather’s behavior, I believe that a tendency to Asperger Syndrome can be inherited, but whether science confirms this conclusively will depend on future research.

Asperger Syndrome is not a disease. In part, I think of the term as a pragmatic label that helps people “wrap their minds around” a certain combination of behavior patterns. Placing those patterns under the Asperger’s label helps both scientists and individuals with Asperger’s and their families to place past, present, and future behaviors into a meaningful “pigeonhole.” Pigeonholes are not always bad things as long as people are not overly legalistic about them. If a pigeonhole helps someone make sense of his life or his loved one’s life, and if it points to an actual pattern of natural human behavior, then the pigeonhole is pragmatically useful.

But is the label “Asperger’s” true? Does it refer to a “natural kind” with stable properties? I lean toward that position. I realize the dangers of over-medicalization of normal variations (and I think Asperger’s is an extreme of normal personality) and of labeling. From my own experience and from the experience of others, Asperger Syndrome does refer to a pattern that is ontologically real–“really real,” so to speak. Now whether Asperger’s is overdiagnosed is an empirical question that can, in principle, be resolved by careful study. More rigorous tests can make diagnosis more accurate. But for those who are accurately diagnosed, they should take comfort that their condition is not just a label–and accept the strengths that arise from having Asperger’s–and work on the weaknesses.

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