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Comment by tehwalrus | Hacker News Reader

Some people have argued [1] that it was not his autism, but his alexithymia which was altered by the TMS. Alexithymia is an orthogonal condition: it can occur with or without autism.

Believing that a "cure" for autism is required is also a rejection of neuro-atypicality as a valid state of being, which is a common form of subconscious Ablism (discrimination against disabled people). That is not to say that no autistic people want to try treatments, simply that we should not forcibly treat all of them (least of all children, which is a line even Robinson himself doesn't argue for crossing.)

[1] https://soniaboue.wordpress.com/2016/04/06/a-shot-in-the-dar...

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There is a really deep question of when does abnormal become a problem, a sickness, or a disability.

For example, homosexuality is rare and decreases the chance of having direct descendants. But would that qualify as an illness or a sickness? In some parts of the world being homosexual can result in a significantly reduced qualify of life, but is that a problem with the person or with society?

Now switch homosexuality for some far less socially acceptable (at least in Western cultures) attractions. How does things change?

Now, say we count out humans for a second (so messy legal/moral concepts like consent are less involved), and apply the thinking to different species of animals. When does abnormal behavior become illness?

Look at honey bees... most of the colony doesn't reproduce and takes roles that limit any ability to directly pass on their genes, but that is how the species works.

The difference between normal and abnormal, well and sick, mentally healthy and mentally ill are problems with not just autism, but with abnormal psychology in general.

> For example, homosexuality is rare...decreases the chance of having direct descendants

The gene for male homosexuality is actually propagated via over-fertility in females with the gene (i.e. gay guys' sisters have more children to compensate). So, reduced direct descendants yes, but reduced passing on of genes no.

> Now switch homosexuality for some far less socially acceptable...How does things change?

That involves moving out of the realm of consenting individuals. That is what changes.

I agree that there is a point at which abnormality becomes illness - my (draft) definition is drawn when the abnormality causes pain (especially chronic pain), or early death.

That applies to most old-school illnesses, but not to homosexuality, or autism, or some other disabilities like being short a leg. Specifically on being able to reproduce, I wouldn't say that a mule was disabled, even though it has an odd number of chromosomes and is therefore sterile. Same with the bees; although hive-based species are always going to seem weird to mammals like us.

Other disabilities, like arthritis, do meet the illness threshold because they do cause chronic pain. With this definition, those with disabilities may ask for additional equipment, support, or perhaps even elective interventions like TMS, but only those with illnesses need medical interventions (whether to mitigate or cure).

>That involves moving out of the realm of consenting individuals. That is what changes.

Note that I also said we can avoid this by only looking at other animals where notions of consent don't apply. Ideally psychology should realize that consent is a human abstraction.

>I agree that there is a point at which abnormality becomes illness - my (draft) definition is drawn when the abnormality causes pain (especially chronic pain), or early death.

Look at honey bees again. How much longer could individual drones live if they didn't sacrifice themselves for the colony. But wouldn't selfishness be a big problem for the colony as a whole? We cannot optimize on either the individual nor the colony to determine what is a mental illness.

Also, consider issues of causing pain to others. Every animal that eats meat causes pain to the victim it consumes. But that is clearly normal behavior.

And I'm sure we can find other examples of things that cause pain to self or others which we would find normal.

>Some people have argued [1] that it was not his autism, but his alexithymia which was altered by the TMS. Alexithymia is an orthogonal condition: it can occur with or without autism.

We don't really know if the TMS actually cured his alexithymia or if it was due to psychological/behaviour factors of the treatment. That would require a placebo-controlled trial. It's certainly plausible that the treatment cured him, as there is a part of the brain that attaches emotions to experiences (the insular cortex). On the other hand TMS will have a huge placebo effect, so this needs to be considered.

It also seems plausible that his lack of emotions is a protection mechanism that protected him from his highly dysfunctional childhood. I would recommend reading John Sarno's books: he has spent 50 years treating people who's problem is the opposite of this. Too much emotion tends to cause chronic pain/fatigue/depression and other issues. So I'm not sure it's generally a good idea to do something like this.

Overall, I don't really see this as being any better than a behavioural treatment designed to help people identify with their feelings. TMS seems too much like hitting your computer with a hammer to fix a bug.

>Believing that a "cure" for autism is required is also a rejection of neuro-atypicality as a valid state of being //

Do you mean to say "believing that if a cure is found that it should be forced on people"?

I liken the position to ocular or aural implants (like cochlear ear implants) - I'd say certainly a cure is required [by many people] but once found we shouldn't then force it on people. Which I think is what you're saying too?

Apart from using "cure" to describe it, we agree.

Well, it is a cure. A cure is something which removes a condition, be that an ear infection or autism.

OK, thanks for the elucidation.

I'm going to come out and say that this is no different than a person born without arms claiming that they're not disabled, that they're not damaged.

To claim we shouldn't cure autism because doing so would "reject neuro-atypicality as a valid state of being" (a typical non-statement) is as absurd as saying we shouldn't grow people new limbs (assuming we had the capability) because it's a rejection of amputeeism as a valid state of being.

In a perfect world, autistic children would be found extremely young and cured before they suffered any real harm from their condition.

I think it's more complicated than that. Perhaps you have a point when it comes to severe autism where the autist, the caretakers, and society clearly 'suffer' to various degrees and nobody benefits in any way. Perhaps.

But this is very much not the case with milder forms of autism. Many high-functioning autists can take care of themselves and even have very successful careers, and there are a number of characteristics typical of autism that are very beneficial to the 'sufferer' and/or society.

I'd say autism, or at least some forms of autism, are like being born with wings. In a society made for arms you have a clear disability. But if you find your way and the right environment, well, you might be able to fly and provide things that 'arm-ies' cannot.

> I'm going to come out and say that this is no different than a person born without arms claiming that they're not disabled, that they're not damaged.

You might want to look at the social model of disability, because there are people who do say this. For example, wheelchair using disability rights campaigners have often said that their wheelchairs are not the problem, but the lack of ramps in shops and workplaces is what causes them to be disabled.

https://en.wikipedia.org/wiki/Social_model_of_disability

That's not a new concept; it's been around since the 1970s.

Makes sense, that folks have been fooling themselves since the '70s. It was that kind of decade.

It's a simple concept. How can I help you understand it?

It's created large amounts of social change. American disability law derives from it, for one example.

Here's a cite from UK goverment mentioning the social model: https://www.gov.uk/government/publications/2010-to-2015-gove...

> We encourage the use of the social model as a way of understanding disability. It says that disability is created by barriers in society.

> The barriers generally fall into 3 categories:

> the environment – including inaccessible buildings and services

> people’s attitudes – stereotyping, discrimination and prejudice

> organisations – inflexible policies, practices and procedures

You probably need to be aware of this, because not being aware of it creates a risk if you ever have any management role.

Of course I'm aware of it. But redefining well-known terms is a sign of groupthink, common among activist group. By pretending words mean a whole new thing, we can identify the in group, and humiliate the out group. I won't participate in that hallucination.

A disability is when you have less ability than everybody else. We can mitigate that by addressing {everything you list above}.

> A disability is when you have less ability than everybody else.

What percentile?

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