(These are non-rhetorical questions, I'm really not sure about the answers to them myself)
They certainly do. And I don't think we can make meaningful comparisons between individuals in terms of their problems, how they struggle or suffer, etc. For me personally, I don't assume to have it any worse than anyone else, and I always assume that others have deep challenges that I won't ever know about.
> Is anyone truly normal or neurotypical?
Again, these concepts become strained when applied to individuals. It's like the family who has 1.5 children: they don't exist. These are ever-changing labels that we make use of within an extremely nebulous social process. I try to apply them only in well-defined contexts and then throw up my hands in the general case.
> Why do some people's problems get the validation of the medical system and others don't?
I have no idea; in my mind this question is trying to peer closely into the nebula.
Very roughly, because some people can't function without intervention (for loose definitions of "function"). And some treatment (therapy, drugs, whatever) can help them function.
Autism 1/Aspergers is sometimes kind of borderline - some people can function with it, but it can exact a heavy tool on them as a sibling comment noted. Depress and suicide are relatively more common. Why go through life miserable if it's not necessary?
People without autism or other diagnosable issues are generally more resilient. a bad week, one-off negative occurrence, etc won't send them into a tailspin. That's a very real concern with some neurodivergent individuals.
And you do have to remember, it's all a spectrum. And as observers, we don't know what a person is feeling/thinking internally and not expressing.
This whole thought that autistic people who appear to have no problems are all secretly on the verge of not just burnout, but AUTISTIC burnout and will tailspin into the nether at any moment is a recent idea I have yet to see any actual evidence of other than self-report. The entire idea smacks of non-falsifiability to me.
If I told you I had to consciously monitor my tone of voice, and mannerisms, and level of eye contact to pass for normal, and had to silently drill these things in my mind before starting or joining a conversation, that I basically had to be like a method actor and get into character before speaking, what would you propose as a way to falsify or verify my claim?
You're right: it's non-falsifiable. And you'd be right to raise an eyebrow about the idea that keeping it up would lead to clinical depression. Doesn't mean it isn't true.
Theres people who go in and DONT get diagnosed with ASD, but get found out to be having other issues, ranging from endocrine to trauma.
The evidence for treatment is the improvement in quality of life for people who do manage to get help.
The control would be people whose challenges make their lives, and the lives of those around them, harder.
And having raised a “high functioning” autistic son, I definitely saw when interventions helped. And I also saw the struggles my son had that his coworkers would have just written off as “quirky”. Sadly, he stopped treatment, was overcome by those struggles, and took his own life, so at least for this sample of one, yes, the interventions help. Right up until they don’t any more.
Because there are effective forms of treatment available, but are gated by diagnosis because of $reasons. Validation of the medical system enables one to access those treatments, perhaps most important of which is being able to tell yourself, as well as others, that you're having an actual problem and are not "just lazy" or need to "just get yourself together", etc.
Yes. I get that your questions appear to be sincere and genuine, but, yes. Relative to the actual, demonstrable, neurological differences in connectivity and so forth in the “neurodivergent” brain, the overwhelming majority of people are “normal”. Relative to the actual lived experience of “neurodivergents”, the overwhelming majority of people are “normal”.
These kinds of questions are asked by people who simply don’t understand the enormity of the difference.
Much like people who don’t have aphantasia speaking to people who do. And so forth.
Aphantasia is one that I find extremely hard to wrap my head around. The notion that somebody who’s otherwise normal can’t visualize things is really interesting. I have a friend who has it. The only outward symptom is his dislike of fiction and most TV/movies (and you’d only notice that if you knew him fairly well).
I think I _used_ to be able to visualize things. I remember feeling frustrated when I was younger and did a more art because I could never imagine the same thing twice when I wanted to draw it. Every time I tried to think about about it, it would have a different pose or texture or orientation. But even then I think I just had a different "level" of aphantasia. I could never figure out how to use color. I kept to pens and lead pencils for art and couldn't get into painting. Even now, staring at a wall and thinking about repainting it, I cannot visualize it with any other color, much less two or three colors for trim and accents.
One of the advantages, perhaps, is that I don't need to close my eyes to imagine things. There's no point, there's nothing there. I may let my focus drift so I don't get distracted by shiny or moving things. But I can stare at a wall, or go for a hike or a run and just let my mind go wild.
That said, I do enjoy fiction, though I never really get "into" anything in particular. In light of this discovery, perhaps it is because I'm not really able to "visualize" scenes to recreate memorable moments, I can only really enjoy it in the moment and maybe recall a few quotes and descriptions, which are harder to get excited about.
ADHD is simultaneously overdiagnosed and underdiagnosed; the case of your brothers' school could be the former, or correction of the latter (or both).
> mostly the kids who would in the past have been described as lazy, which I find hard to believe to be based on actual neurological differences
ADHD manifests as laziness to observers making snap judgements, so this actually tracks - turns out, some of the specific symptoms that, in the past, would make someone branded as lazy, are actually a disorder.
The problem with calling people lazy is that it's a moral judgement, which sometimes may be helpful as a form of corrective social pressure, but absolutely does not help when "laziness" is a result of a disorder like ADHD; it only makes them suffer that much more.
I'm going to give a pretty out-there answer for this: because they piss us off.
A problem is medicalized when the people who have that problem can no longer be ignored, either because the effects are so severe that their demands for treatment become loud on a societal level, or because the effects naturally bother other people.
We started treating HIV/AIDS only after years of the affected communities refusing to shut up about it.
We medicalize mental health issues because the people with them cause problems for the people without them. It is notable that many mental health conditions have names describing the experience of being around them rather than the experience of having them. Attention Deficit Hyperactivity Disorder feels like neither, but people around someone with ADHD get annoyed that they don't pay attention and move around a lot.
For another example, we still diagnose some children with "Oppositional Defiant Disorder".
Also, saying "this deserves medicalisation" and throwing a label on people doesn't mean you're actually helping. Lets say somebody was masking - how would medicine help them?
I agree about medicine not really being the solution, though. If an environment requires masking all meds can do is suppress symptoms, at best.
Not strong evidence but what exactly is the evidence that autistics are going around masking far more than the average bear? Low social motivation is an old theory for the cause of autistic social behaviours which is a theory which would indicate less masking. I’ve heard all this mask mask mask talk over the last few years, but I haven’t seen any persuasive science.
I should also be clear - I’m not saying autistic men don’t mask, or don’t struggle with masking, I’m saying I can find no convincing evidence that autistic men as a group mask an unusual amount. The diagnostic criteria does not indicate masking as a symptom, just as a potential risk that may confuse diagnosis especially in women by making actual social deficits which actually get you diagnosed harder to detect but not impossible.
For instance, a woman who doesn't react in certain ways to someone's cute baby is some kind of child-hating alien monster.
The man who doesn't react in those ways is assumed to be wanting to do that, but actually masking in the other direction so as not to appear effeminate.
When I'm meeting with representatives of a client, and one of them makes a suggestion that I know won't work, and I refrain from instantly and publicly shooting down their idea and instead I make a show of considering it, then ask them a probing question or two that let them realise the problem with the idea themselves - am I masking? Or am I merely being professional?
When I see something worthy of a compliment and I rehearse it in my mind to make sure it isn't objectifying or creepy, and that it's personalised to them and shows I paid attention to and understood the thing I'm complimenting - am I masking? Or just being charming?
When I'm socialising with people who are talking about their struggles to lose weight, and I in many years going to the gym have struggled to gain weight or visible muscle, but I keep my mouth shut rather than trying to build rapport about our shared inability to reach our target weight because I've tried it and I know it doesn't work - am I masking? Or just showing a normal level of social skills and empathy?
My face is usually flat, and my tone is usually monotone. Most people modulate their face and their tone naturally and don't have to think about it. When I socialize, I have to think about my face and my tone constantly. Yes everyone is doing this at some level, but for autistic people it takes as much effort as the thing the socializing is meant to accomplish, so that part cannot be enjoyed or suffers as a result of the intentional masking.
Another example is I have echolalia, which means sometimes I have an involuntary urge to repeat things that I heard earlier. I also have various tics where I move my body in wild ways that tend to make people uncomfortable or look at me in strange ways if I do them in public. When I'm socializing, I suppress (mask) all of these urges. I'm sure that most people suppress urges to move their body and make noises in public, but not in a way that autistic people suppress these urges -- again it comes down to it being a conscious effort that causes discomfort. I would compare it to having to sneeze for an entire meeting; all you are going to think about is having to sneeze, and the disruption you will cause if you sneeze and everyone will look at you. But it's not a simple sneeze, it's an action that everyone will talk about and gossip about later, something that will ostracize you.
Another thing I do when masking is more like mirroring. I'm constantly monitoring the situation to figure out how to respond, since I can't use the content of people's words I have to use contextual cues to figure out the appropriate way to respond. For instance I can know a joke is being told by the way someone is telling it, but I might not be able to tell you why it's funny based on the content. Still, I can laugh at the joke but I'm not laughing because I found it humorous, I'm laughing because I discerned the appropriate social place to laugh. And yes people laugh at jokes they don't understand all the time, but for me this extends to everything. I don't know when people are being mean to me, or flirting with me, or scamming me in real time. It takes days, sometimes years of reflection for me to figure out the actual social context of a situation I've been in.
I'm sure all this is true for many people, as I can't imagine socializing is easy for anyone. I do see people who can effortlessly talk with anyone and everyone, and I wonder how they do it, and if they face the same kinds of struggles as me when they go home and decompress. Do they stay awake all night replaying every social interaction from the night before? Do they have to spend days recharging before they can go socialize again? I don't know. But for me it's true to a degree where it makes me never want to go outside again. And that's what makes it a disorder instead of just a quirk or something everyone does.