Monday, December 17, 2018

Reading the Research: Neat Little Fallacious Boxes

Welcome back to Reading the Research, where I trawl the Internet to find noteworthy research on autism and related subjects, then discuss it in brief with bits from my own life, research, and observations.

Today's article talks describes a bit why having labels for personality disorders isn't necessarily helpful, and advocates for "dynamic analysis," ie: analyzing the specific person and tailoring care to them, rather than the label.  This same philosophy is relevant to the whole of psychology and autism supports and care, as I'll describe in a bit.

People like neat and tidy categories for things. 

This is as true for mental illness and developmental disorders as it is for things like race, sex, and gender.  The 44th President of the United States, Barack Obama, is a US citizen of 1/2 African and 1/2 non-Latino white parentage.  When it came to describing the man, however, everyone pretty much just called him "black" or "African American."  Such a description loses the beautiful complexity of his life, but it was what people chose. 

Sex and gender are similar.  US society in the past has been conditioned to think of both these subjects in terms of binary, but that's accurate for neither one.  Here's a link to a really gorgeous infographic about how genetics don't conform to the "male or female" designations for physical sex.  Also, I did a piece a while back on gender, with a focus on transgenderism.  When you look at any given person, or speak to someone on the phone, you automatically make an assumption about their sex and/or gender and which pronouns you should be using. 

Mental illnesses, developmental disorders, and personality disorders all fall into this same kind of trap when it comes to professionals.  The DSM (Diagnostic and Statistical Manual) used by psychologists and other mental health professionals lists various disabilities, conditions, and disorders, and directly after them, their hallmark traits.  Professionals, by virtue of their jobs and frequent use, tend to memorize these criteria.  As such, the criteria are recalled each time they come into contact with that diagnosis.  

The thing is, people are people: complex, messy, and not at all cookie cutter.  Personality disorders don't change that, as this study says.  Treating one person with antisocial personality disorder exactly the same as the next person with antisocial personality disorder won't necessarily have good results, because people differ and therapy and supports need to be personalized.

The same thing is deeply true for autistic people.  I've complained repeatedly about how autism comprises a truly staggering number of different kinds of people.  Dr. Stephen Shore's famed quote, "When you've met one person with autism, you've met one person with autism," is often repeated, and for good reason.  What works for one person may not work for another, and the symptoms one autistic person has may not match another person's symptoms at all.  

Because of this, individualized care is mandatory.  Simply looking at a person's alphabet soup (list of diagnoses) doesn't tell you what exactly they're struggling with, and what supports and services and treatments might help.  You have to get to know the person and their challenges before you can make recommendations.  

As someone who routinely gets put in boxes they don't belong in, I find the human tendency to put things and people into neat little boxes extremely tiresome.  It may serve a purpose, but when it comes to live people, it has be balanced with thoughtfulness, empathy, and observation.  

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