On Absurdly Poor Criticism And Advocate Misconduct, Part One

On September 14, 2013, exactly a month before I started writing this post, I was contacted by a colleague who expressed an interest in changes in behavioral practice since Lovaas's original methods and models of clinical treatment.

During the resulting exchange, I attempted to explain a variety of things related to behavior analysis, ranging from how ABA is not a treatment method to the relationship between ABA and PBS (the short version is that PBS is a brand-named philosophy regarding how to go about conducting and using ABA research). I also provided her with a number of assorted articles and writings on the subject, including a piece of my own work which acted as an overview.

I ended the exchange on something of a positive note, hoping that the information would help. The positive note, however, did not last.

This is what she wrote... or, at least, the currently-published version. There has been a rather spectacularly intellectually dishonest edit in the interim. It's, to put it mildly, an extraordinarily poor critique. The arguments are, by and large, spectacularly off-base, and her abuse of my writing is glaringly obvious (if not as much so as before the edits).

That said, I should probably discuss what this means and why it's a problem before I get into a detailed critique of the piece itself.

Contrary to what some people apparently believe, saying that a critique is poor does not mean that one disagrees with its conclusions or that the critique does not deal with real problems. It is saying that the critique misidentifies the issues involved and/or argues from a position of misunderstanding or prejudice.

In this case, the author is attempting to argue that all forms of applied behavior analysis are inherently unethical -- a very, very strong conclusion, one that simply does not follow from the evidence (such as it is) and arguments (such as they are) that she presents. Saying so isn't defending ABA, and certainly isn't excusing, justifying, or apologizing for the assorted abuses with which people have valid complaints.

This is important for several reasons -- not the least of which is that poor criticism serves to distract from real issues, detracts from good criticism, and confuses issues in ways that impair efforts to reform things.

To illustrate this, let's take a very different example, one that most of us can rapidly identify, easily understand, and generally make easy sense of: one of the more disgusting things which occurs whenever news story publishes a story about a black man raping a white woman.

Rape is obviously wrong: it's a gross violation of  a woman's bodily autonomy, a dehumanizing act which can easily (and often does) destroy her life. It is very difficult to think of a worse violation of someone's personhood... and the ethnicity and skin color of perpetrator and/or victim is utterly irrelevant to this.

Unfortunately, however, some people insist on making the moral issue here about race in a variety of ways. One of the simpler (and more vile) of these is to simply state that the act was wrong because a man like that (a black man, not a rapist) has no business sexually touching a White woman.

This is an absurdly poor (and racist) criticism of rape. It is one that needs -- urgently -- to be shouted down and combated whenever it pops up.

Referring to this sort of thing as poor discussion or off-base criticism is very much not excusing the heinous criminal act to which the alleged criticism was directed. It is simple truth.

The race thing serves to distract from the real problem. To the extent to which it gets attention, it's distracting people from paying that same attention to other, more relevant, criticisms.

But... let's say that some people actually took it seriously. Let's further say that they then tried to use it as the basis for political reform efforts.

These efforts would be useless at best and harmful at worst. In fact, that particular criticism can pretty much be considered a form of rape apology in and of itself: if the rape of a white woman by a black man is only heinous because of the race difference, what's wrong about a white man raping a white woman?

More, such "reform" efforts would likely target and harm completely innocent interracial couples. In fact, such prejudices and acts have historically caused very substantial harm in the form of blatantly racist legislation and various racial prejudices for just this reason.

Obviously, this has little directly to do with the ABA article which started this discussion, but does serve to illustrate a few very important points: 1) poor criticism is rarely helpful; 2) poor criticism is often harmful, even when its conclusions may be correct... and 3) stating that an argument is poor is not the same thing as stating that its conclusion is wrong.

In Part Two of this series, I will hopefully get to precisely why the specific critique that started this is poor and unlikely to be helpful. In Part Three, I will discuss just why I'm taking such pains to lay out these problems, why a simple blog post like that has lead to me starting an extended blog-rant, just what followed from the situation, and why it's taken me so long to post all of this.

Still Yet Another Note on Vaccination

Just got vaccinated again -- and still don't feel any more autistic.

Not even a bit of soreness this time!

On Autistics Speaking Day

Today is, once again, Autistics Speaking Day. Through happy coincidence, it also happens to be part of the early voting period in my state's election cycle during a major national election.

I live in Florida. Those of you familiar with practical politics here in the US should have some idea of what this means regarding the significance of my vote.

Guess what? I chose to make my voice heard in a far more significant way than a mere blog post.

It took, as it happens, about forty minutes, most of which was spent in a line. For those of you who go, I recommend bringing a book -- the paper kind -- because the legality of cell phones and the like in voting areas is... well, an issue. It's illegal to use them here; no idea about elsewhere.

And, if the person reading this happens to be a politician? Yes, people with disabilities vote.

And that means that we can vote for (or against) you.

In the end, as I said, that's far more important than a mere blog post. Today, for me, was not just Autistics Speaking Day.

It was Autistics Voting Day.

Yet Another Note on Vaccination.

I just got vaccinated. Again.

Still don't feel any more autistic.

I do feel a bit of soreness, though.

Still Yet More on Vaccination

I just got vaccinated -- yet again! And, once again, the vaccine contained mercury!

Nope, still not feeling any more autistic. I'm noticing a pattern here...

On The Recent Lack of Posts

Of late, I haven't been posting. I want to apologize for that.

Simply put, I managed to pretty thoroughly burn myself out. For a while, I was in no shape whatsoever to blog (especially on top of my other committments), and I'm afraid that I let myself get out of the habit of doing so.

As this message indicates, I'm trying to get back into blogging, and will hopefully follow this up with a number of relevant posts.

A Year In Review

Today is the last day of the year 2010. It is something of a tradition on this day to spend some time looking back on the year that has gone by, thinking and reflecting on the events which have occurred.

Normally, I do so privately. This year, I am doing a portion of it publicly -- on this blog.

For me, the year started off with the Zakh Price case. There are some situations that you just can't leave alone; for me, that was one of them. I won't discuss what my role in the whole matter was, but I did play one. I don't know if I, personally, made a difference... but I don't really care. As of the last I heard from the family (which was late summer or early fall), Zakh was doing quite well... and the situation had been resolved in a favorable fashion. In my honest opinion, that's all that really matters.

In other news, Andy Wakefield lost his medical license that month, and I very much enjoyed the 2010 CARD conference (although it was marred by one highly bigoted pseudo-scientist pretending at a neurology presentation). I was actually at the conference (or, more accurately, in my room at the conference hotel) when I found out about Wakefield, and it was all I could do to avoid waking my neighbors with a whoop of joy.

Then I got back and immediately (i.e. the very next day) went in for a much-needed knee surgery. I was on crutches for more than two months.

I discovered that the James Randi Educational Foundation is physically located not that far from my house... down the street from a psychic and across the street from a chiropractor. I've very much enjoyed their periodic open houses... and Randi himself is quite entertaining (and a breath of fresh air).

On the advocacy front, the Geiers moved into my metaphorical backyard and started peddling the "wonders" of chemical castration to the parents of local autistic children, shielded by a number of highly-influential political figures and using a local radiologist as their local patsy. I've been trying to "deal with" them ever since.

I got into a long and protracted series of misunderstandings that I still can't figure out a way to rectify (and that is still bothering me). Actually, that technically started last year... but it continued (and got a great deal worse) this year.

I resumed the MS Counseling program at Nova Southeastern University... and promptly had my first major issue with a postgraduate professor. It says something when it takes a flat-out written statement of intent to discriminate (in the form of deducting points for autistic literalism) for me to consider something a "major issue". I also got my first postgraduate B... in his class. Had it been any lower, I'd have challenged it; as is, I have the written notice available and thoroughly documented to show anyone who questions me about it.

Honestly, what sort of professor does something like that in writing? Seriously!

In a bit of irony, it was actually a bit worse: I received that written statement literally the week before I was scheduled to speak at Autreat. I'll get back to that in a bit, but the sheer hilarity of the timing has lead to a number of jokes since... especially since the professor was aware of both my diagnosis and my presentation.

I also did a brief internship at a small local school for individuals with severe developmental and intellectual disabilities. The kids there were very interesting (and very different from any population I'd previously worked with). Incidentally, for any parent from here on who tells me that I don't know what kids like theirs are like (to insinuate that their child is more severely disabled than any I've worked with)... yes, I do. Working with that population can be a serious mind-fuck, and I do not shy away from the use of that particular vulgarity in this case.

Then my internship ended (with the end of the academic year) and I started working for a behavior services company in Dade County. I've been doing part-time human resources work for them... which does, at least, help pay my expenses.

And, of course, I gave my first conference presentation: a presentation on pseudoscientific medicine in the field of autism. I've done related blog posts here and here, and I posted the PowerPoint slides to the Autreatinfo Yahoo group. I've also uploaded the slides here, if anyone wants to take a look. (Note that I verbally departed from them at several points. I'd be more than happy to explain in more detail if anyone asks in the comments.)

The presentation was two hours long, involved one hundred and fifty-five PowerPoint slides (of which five were references and suggested further reading), and contained thirty reference citations (not counting duplicates). During the preparation, I read far more than this -- my lit review for the thing involved over two hundred peer-reviewed articles and five books... of which, two were med-school textbooks.

Thinking back to that time, I am astounded that I managed to keep my sanity. I was, for a while, not only recovering from knee surgery (on crutches), but doing that internship, preparing that presentation, continuing my advocacy work, and taking a course load and a half of postgraduate classes. Yes, I took 150% of a semester's postgraduate coursework over the summer... on top of everything else. It was not particularly smart of me, and I really haven't quite fully recovered from all of that. The fact that most of my "recovery" time was spent working part time while taking a full course load (not, fortunately, the extra-full course load I took on over the summer) of classes while working part time certainly didn't help. My active participation in various student organizations and continuation of my advocacy work didn't help, either.

Fall, by contrast, was fairly... routine. There were a couple of crises which I can't really talk about, and work has been rather frustrating for reasons that I also can't talk about here, but I tried to use the time to recover. I failed.

I also grew pretty thoroughly sick of the MS Counseling program for a variety of reasons, most of which focus on the high bullshit content of many of the courses. I will be reviewing my "diversity studies" textbook later, but I've already reviewed my so-called "ethics" text. Of the two, the "ethics" book was the better one.

As the year pulls to a close, though, I'm filled with some degree of renewed optimism. For one thing, I've switched programs as of the upcoming semester (and I sincerely hope that the MS General Psychology program will actually involve considerations of evidence!). For another, my new program is a thesis program... which means actual research as part of my graduation requirements!

I suspect that several of my regular readers will find my thesis of interest... and yes, I do already know exactly what I'm going to be doing for my thesis. I will comment more on it after I've actually started doing it... but I suspect that one reader of this blog will find it very interesting: it falls under the category of behavioral sciences meta-research and was actually inspired by some of her comments.

The change won't delay my graduation too much... but my new classes are ones which I can hopefully actually enjoy. I am very much looking forward to them.

Hopefully I'll be able to catch up on my accumulated e-mails sometime next year. I'm something like three thousand behind...

So, in conclusion... for everyone reading this, happy new year!

Edit: Corrected a really embarrassing typo.

An Open Letter to Buzz Aldrin

Today is Autistics Speaking Day. For those of you who are unfamiliar with the event, it's an autistic reaction to the highly-misguided "Communication Shutdown Day", a day in which we autistic people make as much online "noise" as possible... on the day in which hordes of people are voluntarily abstaining from our preferred means of communication.

I won't discuss why the whole idea is a bad one. Others have already done so -- far better than I ever could. Instead, I'm going to post an open letter to one of the major participants in this farce.

Dear Mr. Aldrin,

When I was a child, the Apollo missions were a great inspiration to me. They truly stand out among the achievements of mankind as a spectacular triumph of science and a shining example of what man is capable of if we truly try. You, along with the other Apollo astronauts, were my childhood heroes. Your triumphs fanned the flames of my love of science, helping raise it from the bare embers of a childhood interest into a lifelong passion. Your successes comforted me when things seemed hopeless, helping to reassure me that even the seemingly impossible was often within reach.

Today, I am a graduate student in Nova Southeastern University's M.S. Counseling program and working towards board certification as a behavior analyst. My dream is to go into psychological research and to help raise the standards of the discipline to the point where psychology and the other "soft" sciences can be legitimately compared to the "hard" sciences in terms of methodological rigor... and to come, bit by bit, closer to the countless truths I seek. This is not to say, however, that I do not face substantial challenges in reaching my goal.

The worst of these challenges are prejudice and fear. You see, I have a disability. One of my professors flat-out told me (in writing, no less) that having it was unprofessional... in a course where a third of the course grade was participation and professionalism. My clinical ethics textbook states that I am not human. Fear-driven efforts to create a world without people like me in it have already claimed countless lives throughout the world, including at least ten innocent babies in California... this year alone. There's even a clinic within easy driving distance of my house dedicated to chemically castrating people like me.

My disability is most commonly called "autism".

This is why it hurt me so incredibly much to hear that you, one of my childhood heroes, has been raising money for a fear-mongering antivaccine group dedicated to the goals I mention above. I can only hope that you did this out of ignorance; the thought of you having done so knowingly just hurts far too much.

As you may or may not know, the proceeds from Communication Shutout Day go to the program's "global partners". In America (outside Colorado), this means Giant Steps, the Hollyrod Foundation, and the National Autism Association. It's this last which is the most concerning.

The National Autism Association is an anti-vaccine group dedicated to promoting untested, unproven, and often dangerous "treatments" for autism. They praise intravenous chelation (which risks death and brain damage, and, more importantly, involves pumping an irritant into a child's veins for at least two hours at a time). Their 2009 conference, which was held within walking distance of my house, featured a keynote presentation by Andrew Wakefield (whose unethical conduct and Mengele-like "experiments" were largely responsible for major measles outbreaks throughout Europe), a presentation blaming my neurology on MSG in vaccines, and a presentation on why my neurology should be considered a disease (among countless other things). One of their past conferences even involved a keynote from an infamous quack who makes his living chemically castrating autistic children (and who is responsible for the clinic near my home). They recently were involved in a concentrated effort to effect legislation here in Florida which would have effectively banned the flu vaccine. I am perfectly willing to provide references and further information on any of these assertions on request.

Mr. Aldrin, you are old enough to remember many of the diseases which vaccines prevent. For instance, with polio alone... the iron lungs, the countless children who were crippled for life... to groups such as the NAA, bringing back these things is worth it if it means not having people like me or my friends around. You should also remember Jonas Salk and his heroic dedication to the welfare of the children of the world. To groups such as the NAA, Jonas Salk and countless others like him are villains. I find it difficult to express the sheer perversity of this.

I will admit that the NAA has also campaigned against the more "classic" abuse of children with disabilities in the forms of seclusion and restraint. This, however, mainly serves to help legitimatize them and to help them lend support to other, wackier anti-vaccine organizations such as Generation Rescue, SafeMinds, and the National Vaccine Information Center. In a recent conference presentation on the NAA, I referred to them as a "gateway organization" because of their function in such groups' recruitment tactics.

I won't pretend that this is the only thing wrong with Communication Shutout Day. I strongly encourage you to read what Ari Ne'eman of the Autistic Self-Advocacy Network has written about the matter ( http://www.autisticadvocacy.org/modules/smartsection/item.php?itemid=122 ) and to peruse the various online writings relating to Autistics Speaking Day and the reasons for it.

In the meantime, however, I have to go to bed tonight knowing that one of my childhood heroes has chosen to raise funds for a group whose dedication to creating a world without people like me in it is so strong that they are perfectly willing to sacrifice the lives of countless innocents to create it.

Sincerely,

Alexander Cheezem

Still More on Vaccination

I just got vaccinated yet again -- this time the vaccine even contained mercury!

I'm now heavily perseverating. Oh, wait. That's normal. Nope, still not feeling any more autistic.

Another Comment on Vaccination

I got vaccinated today -- against three different illnesses. I still don't feel any more autistic.

My arm is a bit sore, though.

On Donald T

As part of my studies in autism, I've read Kanner's original article multiple times. The case that I've paid the most attention to -- and studied across multiple articles -- is that of "Donald T"... in large part because it was the first. I've followed it across multiple papers, and even spent a while last year looking for any and all available information regarding him in the literature. The most recent information, however, was in a 1971 followup -- after this, there was no real information on what happened to the first person to ever be diagnosed as autistic.

That changed recently. As I found out this morning, reporters for the editorial and literary magazine The Atlantic (which has a really long and interesting history) managed to track Donald T down and wrote a genuinely fascinating article about him.

Go. Read. Then come back.

Finished? Good.

The article's nowhere near perfect. It gets some things wrong. It has some bad information.

Still, Donald himself is the main point... and I don't think that needs any further remark. The main takeaway message remains: At the age of 77, Donald Gray Triplett, the first person to ever be diagnosed as autistic, is doing just fine.

On "Inclusive Resource Lists"

I wrote the following in response to a request for assistance in putting together a directory of resources for the parents of autistic children. I've edited the formatting and changed a few details to reflect the formatting options I have here on Blogger; other than a few formatting things (parentheses and quotes replaced with a block quote, etc.) and one spelling correction, the message remains substantially unchanged.

In other words, you want to create the resource-list version of Wheeler's (2003) thought experiment.

To quote:

Suppose a medical centre were to propose creating a programme in 'unproven and dubious medicine'. In this programme, physicians would learn how to give patients not only conventional treatments, but also treatments not known to be safe and effective. Some of these would have plausible mechanisms of action, but others would make no sense. The treatments would include experimental drugs of unknown purity. There would be research concerning the methods, but in the meantime the methods would be used before the results were known. Patients would have the benefits of both worlds – treatments that work and treatments that probably don't work.

A programme with such a title would find little acceptance. But change the name to 'integrative medicine', downplay the lack of evidence, claim that it deals with healing the person and employs new paradigms, and for some reason there is much greater acceptance. (p. 8)

You want to list people who make their living chemically castrating autistic children in the middle of people who've dedicated their lives to helping treat actual disease; you want to list people who make their living torturing kids next to people who've spent their lives trying to protect children. You want to list fear-mongering hate propaganda next to legitimate resources on parent education.

Err... no. I have no intention of helping with the development of such a "list". There are more than enough of them already.

This sort of thing is a tremendous problem in the autism world.

What would people make of a "resource list" that deliberately put legitimate stockbrokers and investment funds next to known con-artists? Yet, for some reason, people seem to think that lists that do this sort of thing are okay for parents of autistic children.

Some of this comes from the postmodernist belief in constructed reality. If you don't believe in an objective reality -- if people agreeing that something is true is enough to make it true -- then the question of what's actually going on is both meaningless and irrelevant within your paradigm. Despite what postmodernism would say, however, ignoring objective facts and attempting to construct your own reality independent from them is better known as "self-delusion" and acting on this sort of thing tends to produce tragic results. Quite frankly, this sort of attitude is patently absurd.

Despite this, however, many parents somehow view fraudulent resources as equal to real ones, "alternative" medicine as equal to real medicine, and hate propaganda which gives them false hope as superior to truths which offers them real hope (if at the expense of accepting things they don't want to hear).

I don't get it. I really, literally, don't... at least on an emotional level. Intellectually, maybe (at least somewhat), but that's the difference between "knowing" and "understanding".

Unfortunately, postmodernism only accounts for part of the problem. Bigotry, normocentric bias, and countless other factors also contribute. The results, however, speak for themselves. Parents of newly-diagnosed children usually lack the ability to distinguish between legitimate and illegitimate resources. They are at their most desperate, their most confused, and their most emotional. They seek a helping hand from anyone who offers it... and rarely notice the metaphorical dagger aimed at their backs. They are prime victims for frauds and con-men.

Many of them get wiser as time passes. Many of them learn the skills they should have been taught from the beginning... but it's easy for irreparable harm to have been done by then. If they're lucky, they'll only have been scammed out of money. If they're less so... the potential dangers are difficult to underestimate. In countless ways and for countless reasons, fake help is worse than no help.

I'd be more than happy to help someone assemble a genuine, reliable resource list. I will not, however, help with this sort of "project".

On My Recent Conference Presentation

My Autreat presentation went pretty well, I think. I uploaded the slides to the conference's Yahoo group, if anyone's interested.

Or, alternately, feel free to ask and I'll send them to you.

On the flip side, things have been extraordinarily hectic here. Between an "interesting" (one of my professors has decided that deducting points from my grade for autistic literalism is acceptable behavior), being swamped with schoolwork, and being otherwise preoccupied, I haven't really been able to spare much energy for blogging.

That said, however, I really should have written more. Sorry.

In any case, I just realized that I'd only posted one of the two essays I sent in as supplementary material for my presentation. As such, I'm posting the other:

How does it harm autistics?

Pseudoscientific medicine intended to "cure autism" harms autistics in a wide variety of ways. First and most obviously, the treatments themselves are often harmful. The financial harm to families is often substantial, with many families spending simply absurd amounts of money – some even mortgaging their homes – to pay for "treatments" that can be considered fraudulent at best. Many pseudoscientific treatments require considerable effort to implement while delivering illusory or placebo-equivalent benefit (or even producing harm). Families become emotionally invested in the method, and are often incredibly disappointed when it doesn't work. Sometimes the family avoids this disappointment by seeking out ever deeper and darker depths of woo.

The acceptance of pseudoscientific medicine promotes substandard care due to undertrained practitioners who bypass the relevant licensure requirements. It imposes double-standards on pseudoscientific and scientific practitioners, standards which inevitably favor the pseudoscientists and undermine the constant efforts of scientific practitioners to improve standards of care. It provides false knowledge of how to deal with real problems, and encourages people to ignore, disregard, or remain ignorant of a wide variety of standards of medical and research ethics, and encourages default logic in treatment.

It provides countless confounds to research aimed at helping professionals understand and help autistics and interferes with the conducting of such research, making it harder for genuine scientists to recruit participants.

It encourages the reification of autism, demonizes our neurology, and acts to dehumanize autistics. It promotes a culture of desperation and prevents acceptance of our differences. It legitimatizes the exploitation of us and our neurology by various political groups. It even distracts from real issues and endlessly complicates the discussion on autism.

Perhaps it is more meaningful to ask, "How doesn't pseudoscientific medicine harm autistics?" It would certainly be a far shorter list.

It's worth noting that the list in the presentation itself was longer -- I added several items after I wrote the above. Sometimes "Gyah" doesn't quite cut it.

For My Upcoming Conference Presentation

The following was written for my upcoming conference presentation on pseudoscientific medicine. It is one of two essays which, collectively, make up my contribution to the conference's program packet. All links within the essay are added for this blog and not in the packet itself.

Throughout society, people are being constantly bombarded with unprecedented amounts of medical information. Unfortunately, much of this information is distorted or wrong… and most people don't have the ability to separate the good from the bad.

It doesn't help that making sense of medical information requires a good deal of expertise. There are entire disciplines of study within medicine dedicated to doing this, and it is quite possible to go to college and get a master's degree or even a Ph.D. in the study of doing so. Some of the most influential doctors in academic medicine today have done exactly this, granting them degrees in such seemingly esoteric disciplines as medical bioinformatics and biostatistics.

Any discussion on all of the ways that things can go wrong and misinformation can arise would need to be absurdly long – it happens in many and myriad ways, and even listing all of them could easily fill an entire book. This presentation is intended to cover one tiny subset of one tiny aspect of one tiny facet of a broader problem: the issue of autism-related pseudoscientific medicine – medicine and medicinal information within the field of autism which pretends to be based on science but actually isn't.

Medicine is commonly defined as the science or practice of the treatment of disease. While this seems fairly straightforward, it actually isn't – the concept of disease is complex, multifaceted, and often controversial. MedLine Plus provides the following definition:

Disease – An impairment of the normal state of the living animal or plant body or one of its parts that interrupts or modifies the performance of the vital functions, is typically manifested by distinguishing signs and symptoms, and is a response to environmental factors (as malnutrition, industrial hazards, or climate), to specific infective agents (as worms, bacteria, or viruses), to inherent defects of the organism (as genetic anomalies), or to combinations of these factors.

In other words, a disease is a harmful dysfunction – a "breakdown" of the body, regardless of its source. A traumatic injury is a disease. Heavy-metal poisoning is a disease (or, more accurately, a type of disease). Polio is a disease. Geneticists can't agree on just what a genetic disease is, but some genetic conditions are indisputably diseases.

As such, medicine is the study – or attempt – of keeping the body from breaking down. Medical views of autism must necessarily look at autism as some form of breakdown of the body: views that do not do this are not medical in nature.

Within scientific medicine, the ideal is to provide information and to practice based on critical evaluation of the sum totality of the available scientific knowledge on any given topic. Unfortunately, this is often not possible or practical in a clinical environment for a variety of reasons… but I have tremendous respect for those doctors who put in an earnest effort towards achieving this lofty goal.

Others simply practice the way they were taught to, or as experts recommend. They may parrot their lessons from back when they were in medical school, or simply repeat what various authorities tell them. This usually yields results which technically work – experts often know what they're talking about and medical schools usually teach effective treatments – but new research is always coming out; new developments occur on a regular basis; new findings constantly change the landscape of medicine; and experts, no matter how revered, are never infallible and are sometimes misunderstood. As such, people who practice this way often have information which is out of date, and are at heightened risk of error.

Some people eschew the framework of science entirely and attempt to heal or prevent illness through other means entirely. Ranging from Christian faith healers to psychics to traditional practitioners of Eastern medical systems, their advice has little to do with what we call "science". These systems range from the relatively harmless to the utterly destructive, from the daughter who prays in church in hopes that her mother will recover from illness to the African witch-doctor who tells desperate seekers of help that AIDS can be cured through sexual intercourse with a child.

And, finally, there is the subject of this presentation: those people who do not practice based on science, but simultaneously pretend to. Whether out of financial interest, political ideology, devout cronyism, or simple ignorance, their advice is usually poor, commonly ineffective, frequently bewildering, often harmful, and collectively stands as an ongoing threat to the lives and welfare of countless people throughout the world.

Welcome to the weird and wonky world of pseudoscientific medicine. For the sake of your health and sanity, you're probably better off if you don't move in.

On Freudian Psychoanalysis

As part of my theories and practice course, we're being asked to summarize the various theories and modalities of therapy by answering a series of questions. We started with classical Freudian psychoanalysis.

The following are the questions and my answers -- somewhat cleaned up.



1-How does the theory conceptualize the basic beliefs about people...does the theory see people as "good", "bad", neutral, capable of growth, proactive or reactive to the environment?

Based solely upon extremely low-quality evidence of dubious validity, Freud believed that we were unaware of the majority of our mind's content and essentially at the mercy of forces beyond our direct perception. As such, Freudian psychoanalysis views people as the deterministic result of conflicts between postulated and reified constructs that exist within a non-falsifiable system. To the extent that people are able to grow within this context, it is the result of the client coming to exert control over these constructs and derivative reified "forces".


2-How does the theory describe the function of personality..what is the purpose of our "personality"; what needs does the personality meet..?

In essence, the ego serves to regulate forces/instincts, to manage anxiety, to plan, and to maintain reality focus.


3-How does the theory describe the "structure" of personality -- what IS our personality; what does it consist of?

In essence, Freud believed that the "self" (ego) serves to mediate between a person's "higher" desires (superego) and "lower" desires (id). As such, one's personality is determined by one's ability to balance and control these often-reified constructs and resulting also-reified "forces".



4-How does the theory describe how we develop into a "normal person"?

Freud believed that there was one true course of development (all departures necessarily being harmful) which could be described as going through a series of "psychosexual stages". Specifically, one passes (or should pass) through the oral stage during infancy, the anal stage during early childhood, the phallic stage during preschool, the latency stage during early school-age, and the genital stage during adolescence and onward. The oral stage accounts for the ability to delay gratification and to trust others. The anal stage accounts for independence, the ability to manage and express negative emotions, and acceptance of personal power. The phallic stage accounts for sexuality. The latency stage accounts for socialization and the ability to form relationships. The genital stage, once reached, accounts for all post-adolescent development.


5-How does the theory describe how we develop into "abnormal" people?

If one is derailed from this one true path of healthy development, one develops a number of problems (which may or may not actually be problems). These include (but are not limited to) mistrust and rejection of others, an inability to form intimate relationships, obsession over rules, a lack of appropriate sexuality, and a lack of relationships.



6-How does the theory conceptualize the process of counseling? How does it work, in general?

Freud believes that one developed in therapy by coming to understand and believe in the existence of constructs of questionable validity (except, perhaps, as a metaphor) which describe phenomena which probably can't be appropriately generalized to them, as well as developing control over these phenomena ("achieving insight" or "strengthening the ego", respectively).



7-How does the theory conceptualize the specific techniques of counseling?

Generally speaking, the techniques of psychoanalysis include maintaining a consistent analytic framework and a reliable therapeutic environment, engaging in free association (i.e. having the client talk about whatever (s)he wants without inhibition) in order to allow the therapist to make logical leaps regarding what is within the client's questionably existent unconscious (i.e. interpretations) and to teach the client to accept these conclusions as real, engaging in possibly inaccurate analysis of the content of dreams for meaning which may or may not actually exist in order to teach the client to accept the conclusions of these analyses as accurate, helping the client to overcome any resistance to the acceptance of the therapist's view of who the client is and what the client's problems are, and engaging in possibly-inaccurate analysis of the feelings the client develops towards the therapist during this process (analysis and interpretation of transference).



8-How does the theory conceptualize the roles/responsibilities of the counselor?

Classical psychoanalysis views therapists as "blank screens" for clients to project their feelings for past individuals onto. If the therapist maintains a neutral demeanor and does not engage in self-disclosure, any feelings the client develops toward the therapist are largely assumed to be the client projecting feelings for other people onto the therapist. Additionally, the therapist must listen closely to the client as (s)he free-associates, analyze what is said, and occasionally make interpretations of what (s)he hears, teaching the client to accept the existence of the various constructs created by Freudian theory and to assign causal attribution for feelings and beliefs in a manner consistent with Freudian theory. By aligning the client's view of his self with the therapist's frame of reference and beliefs in Freudian theory, "progress" is achieved.



9-How does the theory conceptualize the roles/responsibilities of the client?

Generally speaking, the responsibilities of the client in a Freudian framework are to cooperate with he therapist as he engages in his responsibilities, to attempt to overcome resistance to his or her acceptance of the therapist's view of who the client is, and to help the therapist develop such a view based on analyses of dubious reliability and validity.



10-What is the utility of the theory...strengths, weaknesses, limitation, applicability?

While our text discusses a number of comparatively minor limitations, these are largely secondary to the lack of empirical validation for large portions of psychoanalytic theory, the non-falsifiable (and thus unscientific) nature of the psychoanalytic framework, the lack of adequate empirical validation of the benefits of therapy (I am unaware of even a single well-controlled RCT which shows a beneficial effect for Freudian psychoanalysis relative to simply having someone to talk to), the focus on teaching the client to accept the analyst's questionable analyses as accurate, the (occasionally realized) potential for severe harm due to this emphasis, and vague criteria for termination of therapy which require therapist/client agreement (and therefore are subject to the various financial disincentives for the termination of a therapist/client relationship).

In terms of strengths, psychoanalysis recognizes the possibility of bias due to a limited set of factors (e.g. countertransference, racial stereotypes) and attempts to teach therapists to counter these. It emphasizes the necessity of a therapist recognizing and accepting who he or she is, recognizes humans as individuals, and emphasizes the importance of understanding the client and the client's problems, and teaches about the importance of a person's history in determining their present. Additionally, it was chronologically the first of the major therapeutic modalities and many of its techniques have contributed to their development.

Also, the couch can be relaxing.

A Few Changes

Classes have started up again, and I am now once again a grad student. My blog's byline has been altered back to its original to reflect this. Expect a bit more free-ranging commentary from me, as I once again use my various coursework as inspiration for blog posts.

Also, due to some recent events in the online autistic community, I'm preemptively adding a policy against personal attacks in the comments here.

On Humor

Taken yesterday from my Facebook profile:

Alexander Cheezem just spent a while chasing after his pet sixteen-year-old, three-legged dog after she ran out of the house. I'm also still on crutches and can't put weight on my left leg. I'm fairly certain that some sort of disability humor can be derived from this, but I'm too exhausted to do so myself.

I believe this speaks for itself.

A Discussion Topic

Around a year ago, I recorded a discussion topic for the Dan Marino Foundation's Autube.tv project. They have yet to use it, much to my disappointment... as I view it as a very important question that doesn't get asked enough.

Fortunately, I'd written out my question... and I still have the transcript. As such, I'm able to post it here.

Hi, I'm Alex Cheezem, a graduate student at Nova Southeastern University and an adult on the autism spectrum. One issue that surrounds any discussion of autism is the matter of language. Words often have different meanings depending on context -- for instance, the technical language of behavior analysis defines an aversive as anything that an organism moves to avoid, while the term often brings up images of ammonia squirts to the face, electrical shock, and other such painful and humiliating "treatments".

At the same time, the spoken languages of our cultures are often a second language of sorts to us. Countless accounts are available of our thought processes and the ways in which we think, but these ways are often alien to those people who think in a more typical manner. The underlying assumptions of these modes of thought are often different from those of what we call the English language.

Finally, much human communication is in the form of subtle implcations and connotations. While people on the spectrum often have difficulty perceiving these, people not on the spectrum often have trouble with correctly interpreting our statements in their absence. Many people on the spectrum have invested a considerable amount of effort into learning this language only to come across in a manner completely unlike what we'd intended.

Do these problems obstruct meaningful discussion of autism-related issues? If so, how can we go about opening a meaningful dialogue? Is there any way that we can keep important points from being "lost in translation"? Let's hear from some voices in our community that can help us frame this conversation.

While not everything in this remains true (specifically, I'm no longer a student at Nova), the question is no less important now then it was a year ago.

On Disability, Accessability, and Analogies

While recovering from my knee operation, I've been thinking about a lot of things. Some of these (e.g. my questioning how the Hell the character of Gregory House is able to function on the meds he takes) have been ultimately trivial and unimportant. Others (e.g. my thoughts on grapefruit/orange hybridization) would likely only make sense to Floridians who have experience with both joint surgery and altered states of consciousness.

Given the state of mind I was in for a while, I am very lucky that I didn't try to peel my knee.

One of the circumstances I've faced, however, is probably a bit more significant... if a great deal more mundane. As it functions as a pretty good analogy to a wide variety of disability-related issues (mostly those centered around accessability), however, I'm sharing it here.

My house has one portible phone. All of the remainder are traditional wired units. On the ninth (a week after my operation), I was sitting in my little recovery area when the house phone rang. The portible unit (which was by me) had run out of batteries, however, so I had to disconnect myself from the machines I was hooked into, grab my crutches, and hobble over to the nearest traditional phone as quickly as I could (a distance of about 20 to 30 meters, give or take). I didn't make it on time and barely missed the call.

Then I found out the hard way that I hadn't brought my cell phone with me. It, still within easy reach of my starting point, began to ring. I attempted to hobble back, but again couldn't make it on time.

Ironically enough, the calls both turned out to be the doctor who'd performed the operation which had led to me being unable to answer. Had I been able to pick up, it might have saved me some of the grief which I am facing at the moment regarding an unexpected complication in my recovery.

Suffice it to say that cold is good for swelling, but too much of it leads to freezer burns (not major ones, thankfully).

Anyway.

Had the call come via my cell phone first (which was much more accessable in both the literal and disability studies senses), I would have been able to simply reach over and answer. Instead, I wound up failing to answer due to my attempt to try the less acessable solution first.

As I said, it's an analogy. Take it as you will. I could probably write up a better article on this, but my rehab efforts are exhausting me and I have a lot of other things on my mind. One of the banes of blogging, that last one is...

On Knee Surgery

On Tuesday, I had knee surgery. To be more specific, I had an arthoscopic procedure intended to help repair an old injury which had gotten very much out of hand.

To detail the situation, my left knee's lateral meniscus was out of place, folded on top of itself, and torn. There was also bone damage, and some of the remaining cartelage had become detached. While the meniscus wasn't salvageable, the remaining damage was successfully repaired... although there was a bone graft involved.

Needless to say, I am not enjoying the recovery. Among other things, vicodin has a very strong negative impact on my ability to follow the peer-reviewed literature. This is a major annoyance to me (frankly, more of one than the fact that I'm now way behind on my e-mails).

Oh, and bone grafts really, really hurt... even with major narcotics. Attempting physical therapy activities with a knee that's swollen to the literal size of a grapefruit isn't very pleasant, either.

In summary, I don't have much energy (or attention span) available for blogging right now. Sorry about that.