Autism Symptoms Get a Second Look

According to a recent article in the New York Times, the revision to the APA’s Diagnostic and Statistical Manual currently underway will reconsider not only the personality disorders (rumor has it that Narcissistic Personality Disorder may be eliminated) but also the autistic disorders. In particular, it looks as if Asperger’s Syndrome will be eliminated as a separate diagnosis and subsumed within the more tightly focused Autism Spectrum Disorder. Read the entire article for an understanding of how the skyrocketing medical and social costs of treating autistic disorders are driving this revision, at least in part.

This change once again throws into question the validity of psychological diagnosis as a scientifically precise methodology. If Asperger’s Syndrome can be written out of the DSM by committee, one has to wonder if it was ever as distinct a disorder as many people have wanted to believe. Even though I object to the very idea of a diagnosis manual akin to the ICD-10, I’m moderately hopeful that the current revision to the DSM is a step in the right direction: the new name, at least, seems to acknowledge that there’s an entire spectrum of autistic disorders. Still, with its focus on symptoms and behaviors (rather than psychodynamic process), this new Autism Spectrum Disorder continues to reflect the kind of pseudo-scientific precision that characterizes the APA and all its efforts.

In working on my book about defense mechanisms, it has become increasingly clear to me that the problem with modern psychiatry is its renunciation of its psychodynamic roots. Whereas psychoanalytic thinking once dominated the American Psychiatric Association of 50 years ago, the continuing revision to the DSM that began in the 1970s has “re-medicalized” psychiatry — that is, made it more scientific, with identifiable diseases leading to sanctioned cures. Psychodynamic thinking has been written out of the clinical picture so that today, we talk about bipolar disorder, borderline personality disorder and post-traumatic stress disorder as if each was as consistent and identifiable a medical syndrome as diabetes, but with no understanding of their underlying psychic processes. (For more on the medicalization of psychiatry, see Robert Whitaker’s excellent book, The Anatomy of an Epidemic, which I reviewed in a series of three articles, beginning with one on the chemical imbalance theory of depression.)

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Anxiety Symptoms, Mindfulness and the Enlargement of the Self

In an early post about anxiety symptoms, I discussed my personal experience with a panic attack several years ago. In particular, I talked about the fear of falling to pieces, a kind of disintegration anxiety; it involved the feeling of a threat to my self in the most physical sense, to my bodily integrity, and the terror that I wouldn’t hold together. Anyone who has gone through anxiety attacks or has any kind of anxiety disorder will likely understand what I mean.

Although I’ve since learned how better to manage my anxiety, and have never experienced another panic attack, this period of intensified stress only recently came to a complete close. Now that I’m on the other side, I’ve begun to realize the toll it took on me, and the ways that my anxiety symptoms affected me in an ongoing way, much more than I realized at the time. I’d like to talk about the experience, my sense of self and how mindfulness meditation techniques have proven useful to me.

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Defense Mechanisms VII: Reaction Formation (Not to be Confused with Hypocrisy)

I’ve begun work on a chapter in my book about the defense mechanism called ‘reaction formation’; as I usually do, I’ve taken a look around the web to see what other resources are available and how others have described this defense mechanism. In particular, I like to see the examples they give to illustrate such a process. The most common examples, you probably won’t be surprised to hear, focus on Republican politicians or religious conservatives with rabidly anti-gay positions who get caught engaging in illicit homosexual behavior.

The most recent instance involved a conservative mayor in Mississippi who ran for Congress on a “family values” platform and was subsequently indicted for using his business credit to cover a vast array of personal expenses, including visits to “Canada’s premiere gay lifestyle store and sex shop” in Toronto. Other famous examples of anti-gay Republicans who have been outted over the past ten years include George Rekers (the guy who hired a young man from to “carry his luggage” throughout Europe), Pastor Ted Haggard of Colorado Springs, who engaged in a three-year sexual relationship with his “masseur”, and former Senator Larry Craig of Idaho, caught playing footsy with an undercover cop in a Minneapolis airport men’s room.

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Depression Symptoms and the Role of Rage

Before I began taking on new clients for online counseling in November, it had been quite a while since I’d started therapy with someone new; for the most part, my practice had involved ongoing work with long-term clients who were no longer struggling with depression. A number of people have recently come to me with depression symptoms and I’ve been struck once again by how important it is to understand the role that anger and rage play in so many depressive conditions.

In an earlier post about different types of depression, I discussed severe cases that result from intensely destructive but unconscious rage; I believe unconscious anger plays a major role in less severe conditions, as well. You’ve probably heard depression described as “aggression turned inward”; accordingly to this view, depression symptoms are the result of unresolved and unexpressed anger that is turned inward upon the self instead of being directed outside, at other people. This might account for the apparently unjustified feelings of guilt that often accompany depression symptoms: while the depressed person has no real reason to feel guilty — that is, they haven’t actually done anything in the external world about which they might legitimately feel guilty — their (unconscious) enraged fantasies of wanting to hurt people around them nonetheless inspire feelings of guilt. As therapists, instead of treating the feelings of guilt as irrational and unjustified, we might instead wonder what the person has done (in unconscious fantasy) to justify those feelings.

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Attachment Theory and the Tenacity of Defense Mechanisms

As you can see from the comments to my last post about attachment theory and the origins of shame, many people are struggling with the idea of lasting neurological damage as the result of failures in early attachment. This is a difficult truth to accept, but we’re talking about scientifically verifiable changes in the brain that result from different experiences during the first two years of life. I have no problem with people hoping that science will eventually figure out how to repair that damage; I can’t argue with religious faith when people believe that their God will do the same. But while we are waiting, full of hope and faith, we must try to make the best use of what we know. Contrary to what one of the comments suggested, facing the truth does not lead to a sense of hopelessness and despair about changing. Rather, it allows us to be realistic in our expectations and to work for attainable change, rather than hoping for salvation from science or God. I would suggest it is the hope for a “complete cure” (instead of facing the truth) than undermines the hard work of psychotherapy.

In an earlier post about the tenacity of defenses, I discussed how our defense mechanisms are mental habits of coping etched in our neural pathways. I’m not a neurologist and my ability to describe the science is limited, but based upon the work of Allan Schore and others, I think we can now expand on this idea. When there are early failures of attachment and the infant doesn’t learn to manage its own emotional experience, it instead makes use of psychological defenses to ward it off; such defenses are built into the structure of the brain as it develops. When an adult comes into my office — a person who relies heavily on denial, his neuro-anatomy has developed in a way — an abnormal way — that reflects the use of that defense. If someone else resorts to splitting and projection, her neuro-anatomy will have developed differently. These defensive strategies are inherent in the very structure of the brain as it developed.

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