Challenging The DSM (1)

Postby davidbanner99@ » Mon Sep 13, 2021 9:37 pm

I posted this on my blog today. I'm fairly happy that it digs into some very problematic issues connected to ASD. Part of the drive was personal. I figure people such as myself will be lost and not properly diagnosed, or supported. Having been failed by the system (back in the 1980's), maybe I owe something to others who stand to be underdiagnosed, misdiagnosed or ignored.
This study is not bullet-proof, of course. Mostly it suggests Wing and Goulde's Asperger Syndrome had a few weaknesses but was better than ASD. This is part 1.
I mentioned before that psychology taught me one thing: Never assume the so-called experts (who dismiss research on the basis of age) have an automatic right to be taken at face value. One major reason I'm not having the vaccine is my trust in experts is cautious. They don't know it all by far but assume they do. I don't know it all either but know I don't.

"Introduction

At this stage in my essays, I believe it would make sense to address the almost universally accepted idea that autism must be diagnosed as “a spectrum”. It may well be the case I am practically the only researcher who, not only questions this approach, but am able to provide evidence that suggests the spectrum theory was discredited by leading European researchers decades ago. Here, as the case may be, I am restricting myself to clinical psychology and diagnosis. Within the confines of non-clinical psychology, the spectrum concept was not as problematic.

There are many reasons why leading psychiatrists (of the early 20th century), urged caution over assessment of clinical pathologies as a spectrum. Hans Asperger himself appears to have ruled out this approach. Even more to the point, professor G. Suhareva stressed the need for “definition”, as opposed to the lack of consistency reflected by the spectrum criteria.

“Defining characteristics of the schizoid personality, as outlined by Kretschmer in Körperbau und Charakter”, are too widely applied. The definition of “schizoid” is too vague and undefined.” (G. Suhareva)

How did the DSM come to adopt ASD instead of Asperger Syndrome? (Part 1)

Back in the 1980s, research into high-functioning autism in Britain, The United States and Australia lagged some other European countries. On the other hand, The Soviet Union, at that time, had been keeping up to date with autism research. Soviet psychiatrists such as S. Munhin and V. Kagan were already familiar with Hans Asperger’s “Die Autistischen Psychopathen Im Kindesalter” and, therefore, the same pathology was familiar to specialists there.
At this point it will help to clarify that the historical terms used to describe the higher functioning autism Hans Asperger described were as follows:

(1) Autistic Psychopathy = the term used by Dr.Hans Asperger himself.
(2) Autistic, Schizoid Avoidant Psychopathy = this is the same as the above, but a fuller definition.
(3) Schizoid Disorder = used widely in the USSR but essentially the same diagnosis.
(4) Verschroben = The oldest term used to diagnose Asperger Syndrome.

Asperger Syndrome, for the most part, is exactly the same clinical condition as all of the above. At least in the more general sense. From the onset, Asperger Syndrome (in its former definition), was associated with Schizophrenia. “Schizoid” means “borderline Schizophrenia”.

In my view, British psychiatrists Wing and Goulde somehow missed this fundamental connection. They attempted to create a new, spectrum disorder, at the same time missing the historical evolution of its original conception. Lorna Wing wrote:

“Furthermore, the word ‘schizoid’ was originally chosen to underline the relationship of the abnormal personality to Schizophrenia……There is not firm evidence of a special link between this syndrome and Schizophrenia.” (Lorna Wing)

Note: Asperger himself seems to have dismissed this link, since he stated he had found no evidence that points in that direction. That probably influenced Wing’s position. However, data gathered by geneticists (Hoffman, Rudin, Kahn, Medow, A. Schneider) reveals how the autism Asperger described is most often found in families where Schizophrenia has had some impact.

All my research to date indicates the pathology Hans Asperger described in the 1940s has a clinical connection to Schizophrenia and this is supported by the following:

“The Schizoid Psychopathic Group has a certain relationship to Schizophrenia. This is supported by the following: Firstly, hereditary-biological data that indicates a large number of schizoid psychopaths within schizophrenic families. Secondly, similarities between the pre-psychotic personality of schizophrenics and schizoid psychopaths.” (Prof G Suhareva)

The problems that confronted the elite psychologists and geneticists of pre WW2 Germany were as follows:

(1) How to provide evidence of a definite relationship and similarity between Schizoid Disorder (i.e. Asperger Syndrome) and Schizophrenia. This involved the research of family medical history and accumulation of anamneses.
(2) How to differentiate between Schizoid Personality as a concrete clinical disorder against a background of contrasting, vague, undetermined interpretations of “Schizoid” as it initially existed. Here, I must emphasise all this initial confusion and vagueness returned to modern psychology through the DSM and A.S.D diagnostic criteria.

I have tried to bring as much clarity to this essay as possible. It is important to bear in mind the terms used by psychiatrists tend to change as history progresses.

The Discovery Of German Clinical Psychology Research In 1980s Britain.

Due to the lack of information, regarding autism, in the English-speaking world, psychiatrist Lorna Wing made the decision to undertake extensive research into this area of clinical psychology. Wing’s daughter herself suffered from autism, yet there was very little support or research available at that time. This motivated a determination to seek whatever research had been developed in other countries. Based in a London clinic, Wing and Goulde observed autistic patients and read translated German research texts. After reading essays by Austrian psychiatrist Leo Kanner, Wing became especially interested in the work of Dr. Hans Asperger. After much painstaking research along these lines, both psychiatrists concluded autism functioned as a spectrum (although, as we have seen this was not in any way a new concept). It was decided to name the new diagnosis after Hans Asperger – “Asperger Syndrome”.

The question should be raised as to whether Wing’s introduction of the autism spectrum concept came to be misunderstood over time. We will consider this point later in the essay.

“There is no question that Asperger Syndrome can be regarded as a form of Schizoid Personality. The question is whether this grouping is of any value.” (Lorna Wing)

In my view, the shortcoming in Wing and Goulde’s research was to omit the fact initial problems surrounding a clinical definition of Schizoid Personality Disorder, had mostly been resolved in 1925 in G. Suhareva’s essays, as already stated. Note the following statement by E. Kretschmer:

“Schizoid type is a pathological personality which reflects the basic symptoms of Schizophrenia to a lesser degree.” (Kretschmer).

To bring this essay to a close, we can now confirm the concept of autism as a spectrum was a very dated, and partly discredited theory which mainly has some use in the sphere of non-clinical psychology."
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Postby davidbanner99@ » Mon Sep 13, 2021 9:44 pm

The Original Theory Of Autism Spectrum (part 2)

The initial conception of a spectrum of symptoms that pertain to neurological deviation was pioneered by E. Kretschmer in his book “Körperbaû und Character”. It was developed by Kahn and Hoffman in the 1920s. For example, Hoffman suggested the Schizoid Personality type functions as a spectrum that reflects opposite extremes. So, in the examples below, the autistic personality may range from flat, emotional unresponsiveness to excessive emotion and feeling.

Hoffman listed a wide range of polar opposites that are merely aspects of one pathological disorder, i.e. Autistic, Psychopathic Personality, Schizoid Disorder.

This reflects the “wide range of clinical pictures” referred to above:

Gemütsruhig = quiet, meek and withdrawn.
Gemütskalt = cold, selfish, avoiding other people.
Gemütstumpf = morally insensitive – Stumpf überempfündlich = excessive emotion.

If we read Hoffman and Khan carefully, it becomes quite obvious they are discussing Schizoid Autism as a spectrum. This is what caused Wing and Goulde to dismiss Schizoid Disorder as irrelevant, thereby losing the demonstrable connection to Schizophrenia.

“Although Wolff & Chick have listed five features operationally defined, that they regard as core characteristics of Schizoid Personality, this term, as generally used, is so vague and ill-defined a concept that it covers a wide range of clinical pictures in addition to Asperger’s Syndrome.” (Lorna Wing)

Hans Asperger had clearly read a great deal on the subject of autism as a spectrum, given his native language was German. The views of leading German-speaking psychiatrists were, therefore, familiar to Asperger. If we read Asperger’s particular approach to the diagnosis of his patients, we ought to be able to interpret his views in modern terminology. For instance, Asperger writes:

“Kurt Schneider divides psychopathic (schizoid) types into hypersensitive, depressive, insecure, fanatical, ambitious, as well as those with mood-swings, explosive, nonchalant, weak-willed and neurotic. Without any doubt, he describes different personality types, while relying upon the resources of applied psychology.” (Hans Asperger)

So, here it is quite clear. Psychologists today would interpret “fanatical” or “nonchalant” as “being on opposite ends of the spectrum”, whereas Asperger goes on to explain why such an approach is unreliable. Moreover, he wasn’t alone in this view.

“Substantial objections to this approach were raised initially by Paul Schroder and his school. They considered the classification of personality types on the basis of one characteristic symptom (schizoid) to be an unacceptable simplification. This meant that all other traits which made an impact on the personality were left aside.” (Hans Asperger)

Personally, I am inclined to be very skeptical as to how people who today struggle with Asperger Syndrome could be identified and supported on the basis of A.S.D. As my articles will go on to demonstrate, Asperger Syndrome can be diagnosed today as a recognised pathological condition. Attempts to interpret the said pathology as A.S.D. risk more confusion than Wing and Goulde’s original efforts to assist people with this condition imagined. Furthermore, on reading Wing’s essays (as mentioned before), it seemed to me to be the case her views on the spectrum issue were inspired by the various, suggested forms of Schizoid Personality. Wing probably never intended her new diagnosis to lose its meaning and clinical integrity:

“There is no question that Asperger Syndrome can be regarded as a form of Schizoid Personality. The question is whether this grouping is of any value.” (Lorna Wing)

As G. Suhareva concluded:
“What’s required is a more precise distinction of the Schizoid Group, in order to distinguish it from, (1) other types of psychopathic disorders and (2) the reactive type of Schizoid Disorder, often encountered as a physiological phenomenon, within the limits of normal variation. For the latter group it is appropriate to seek a term not linked to clinical psychology.” (Grunya Suhareva)

On ending this essay, I should add I have no idea if people affected by Asperger Syndrome are satisfied with the A.S.D. diagnosis. My belief is Hans Asperger himself would have felt his 10 years of research has been ignored and under-estimated. My other article will explain how to diagnose this pathology.
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