Sunday, November 21, 2010

Beyond Bizarre: Some Highly Speculative Retrodiagnosis

(When you've only got one piece of the puzzle, you can put that piece anywhere you like)

Probably because it's still so poorly understood, autism seems to be something of a lightning rod for off-the-wall ideas.

Some of these crackpot conjectures try to contextualize autism's fairly recent discovery, either by drawing a spurious connection with some other recent historical development (widespread vaccination is a popular one), which is supposed to have given rise to autism in the first place, or by spinning out a putative history for autism predating Leo Kanner's 1943 article defining it.

One of the ways of doing this --- cobbling together a History of Autism Through the Ages, when scientific and medical literature about autism began almost halfway through the last century --- is by looking for traces of autistic traits in the life stories of famous historical figures. This is also a spurious exercise, because there aren't anywhere near enough written records from centuries ago detailing people's (even famous people's) infancy and childhood, and getting someone's developmental history is part of the process of diagnosing autism.

However, even considering that the field of autism --- and especially autism's history --- has a pretty high baseline level of speculation and conjecture, I think this article's thesis still stands out among the most bizarre claims ever made about autism.

The article --- published in the current issue of the Annals of Indian Academy of Neurology --- matches up various characters in the Old Testament of the Bible with the neurological disorders the article's authors think they might've had; one such pairing is their suggestion that Samson may have been autistic:
The book of Judges, in Chapter 13 talks about Manoah and his wife, and the child promised to them by God: the child who is named Samson. The subsequent chapters go on to tell us about Samson's search for a wife, his extraordinary physical powers, which helped him win numerous battles. Various researchers and scholars who have studied the life of Samson have offered Guillain-Barre Syndrome and Myasthenia gravis as possible diagnoses. We would like to offer autism as a possible diagnosis for Samson.

The diagnosis of autism is on the basis of behavioral criteria: qualitative impairments in social and communicative development, with restrictive and repetitive activities and interests. It is written in Judges 13:25 that he had violent movements of the body at times in the camp of Dan between Zorah and Eshtaol. This could have been an instance of recurrent seizure episodes. Two separate studies carried out in New York and Sweden state that the incidence of epilepsy is greater among children with autism than in the general population. However, it must also be stated that the greatest risk factor for epilepsy among autistics were severe mental deficiency with a motor deficit, both of which were not evident in Samson.

One of the earliest incidents recorded from Samson's adult life is the journey to Timnath with his parents where he tears a lion with his bare hands. On his return, he finds a swarm of bees and honey in the carcass of the lion, which he eats, and offers his parents (Judges 14:8-9). Abnormal eating is one of the atypical behaviors noted among children with autism.

[Francesca] Happe states that autistics may exhibit a failure to understand deception (manipulating beliefs) but achieve success on control tasks involving sabotage (manipulating behavior). This may be correlated with the fact that Samson believed his strength lay in his hair, which would be lost if his head were ever shaved (Judges 16:17), and that he succumbed to his wife Delilah's wiles (Judges 16). Throughout Samson's life, it is seen that he performed extraordinary physical feats. In Chapter 14, he tears a lion with his bare hands "as he would have rent a kid" (verse 6); in Chapter 15 he kills 1,000 Philistines with the jawbone of an ass; and in Chapter 16 in his final act, he causes the house in which he was held captive to fall by pushing against two pillars that he was tied to, killing more men than he ever did in his life, and in doing so sacrificing his own life. It is possible that Samson was able to perform these feats as he may have been insensitive to pain, which is occasionally seen among autistics. A study of hospitalized individuals carried out in Sweden had reached the conclusion that individuals with autism or autism spectrum disorders are prone to acts of violence.
So, to summarize, here is their evidence for thinking Samson might have had autism: he ate something weird once, he could be deceived, and he was exceptionally strong and a fearsome warrior. That's a paltry basis for a diagnosis even before we consider the unreliability of the Bible as historical record; it might sometimes describe historical events, but it should really be considered more in the light of myth or legend than of factual record.

Indeed, trying to write history while starting from the premise that everything written in the Bible is literally true often leads to absurdity. Some examples: in his book Bad Astronomy, Philip Plait describes the bizarre, and physically impossible, theories of Immanuel Velikovsky, who sought to prove that the events in the book of Joshua, where Joshua stops the sun in the sky to lengthen the day so that the Israelites would win a battle, could really have happened. Velikovsky's infamous book, Worlds in Collision, proposes that the planet Venus was not formed at the same time as the rest of the solar system, but instead split off from Jupiter much later as a comet, zooming around the inner planets causing havoc until it settled down in its current orbit between Mercury and Earth. One of the things Venus supposedly did in this itinerant stage is to pass by Earth very closely, slowing down the speed of Earth's rotation on --- you guessed it! --- the very day that Joshua was waging this crucial battle and had such dire need of a few hours of extra sunlight.

It would be much easier (not to mention more believable) to read the account of the sun stopping in the sky, and similar impossible events or superhuman deeds described in the Bible, as poetic exaggeration than it would be to try to come up with a physical explanation for every single one of them!

Back to Samson, briefly: even apart from the problems inherent in treating the Bible as a totally objective, accurate source --- look back at the second-to-last paragraph in the quoted passage, where they find evidence of Samson's peculiar eating habits in a story about him dismembering a lion with his bare hands, for Pete's sake! And yet they thought this passage sufficiently true-to-life that they could take even its smallest details as fact? --- the things they choose to highlight as suggestive of autism aren't all that suggestive.
The unusual eating behavior, for instance, that they cite in the episode with the bees and honey in the lion's body? That --- while it is certainly very odd --- deviates from most people's eating behavior in the opposite way that most autistic people's eating habits do. Most of us are very picky eaters, who are grossed out by, or just can't stand, lots of perfectly ordinary foods; very few of us would scoop a handful of bugs out of a rotting corpse and pop them in our mouths!

I'm also extremely skeptical of the idea that mere insensitivity to pain would grant you the kind of superhero-like strength and toughness that are Samson's most salient traits. After all, not being able to feel pain doesn't make you indestructible. You can still break bones, sustain massive tissue and organ damage, and die --- you just won't feel it. Someone who can overpower a thousand (presumably armed) men with just a donkey's jawbone for a weapon has something more going for him than just that.

Neuroskeptic and Autism Jabberwocky also have posts up about this odd little paper.


The Untoward Lady said...

Could I suggest that Samson's episode with the goat's jawbone is demonstrative of a particularly vivid example of autistic obsession? Perhaps his ability to overpower hundreds of armed soldiers could be attributed to a 'meltdown' or other deficit in behavior modulation.

Also, his having a beard was clearly a sign that he had sensory issues related to shaving. On the other hand it could have just been an obsession of his which might explain how he seemed to become "lost" when it was taken away from him.

Hey, if it's going to be out there you might as well have fun with it, no?

The Goldfish said...

I loved this. I love it when medical folks try to explain stories from the Bible or Classical Myth in these terms, but your analysis is spot-on. Made my Monday morning.

Lindsay said...

@The Untoward Lady - oh, I agree!

(I also thought of the beard thing as possibly an example of sensory sensitivity; MJ at Autism Jabberwocky thought it could be resistance to change).

DaisyDeadhead said...

I am convinced various saints were autistic--no way to prove it of course.

d. said...

Great. Really great. Where do you FIND this stuff? :D Thanks for making me laugh, out loud. I think I agree with "the untoward lady". It's all about the meltdown...

urocyon said...

I saw the Neuroskeptic writeup, and made my ribs hurt laughing. Good analysis, BTW. :)

Lindsay said...

@d. - I can't take credit for finding this article --- I saw Neuroskeptic's writeup of it in my Google reader.

Lindsay said...

@Daisy - it's certainly possible!

Some autistic people do have the kind of vivid mystical experiences that crop up in some saints' lives.

Plus, if all these various neurological quirks which we've just now, in the last century or so, gotten around to naming have been part of the human mosaic for a lot longer (as I think they have), it's quite likely that at least a few of history's notable figures had some of them.

It's just impossible to establish whether any particular individual would've fit into a given DSM-IV diagnosis.

Lindsay said...

@Urocyon - yeah, Neuroskeptic's a good writer. He's got a keen sense of the absurd. :)

Ole Ferme l'Oeil said...

all this "autistics prone to violence" thing!

As usual in most people head autism seems to remain a collection of stereotypes