R.I.P., Alyric

I learned from The Gonzolog that autism blogger Alyric, who wrote A Touch of Alyricism, has passed away, having fought cancer for a year.

Alyric was not a personal blogger; she preferred to write about the science of autism, the ethics of autism advocacy, and to debunk --- with astonishing wit and grace --- the fallacies of the anti-vaccination cranks and the nastier stereotypes of adult autistics.

Because she did not blog about her own life, I had no idea she was sick. From reading others' blog entries memorializing her, they were equally blindsided.

Even though I did not read Alyric regularly, I did find her blog intensely interesting, informative and well-written. Her husband and daughter have chosen to keep her writings visible online, so people who haven't had a chance to read her can still do so.

Here are some of my favorite things she's written:

"Blueprint for a 21st Century Witch-hunt" - an extended analogy between Internet communities and medieval villages, with specific focus on the way in which certain groups of people (she focuses on autistics, though I'm sure there are others, too) get scapegoated and demonized within these insular enclaves. It also features a lot of amusing figures of speech, of which my favorite would be her likening the "flat affect" characteristic of Asperger syndrome to a "witches' caul."

"Unnatural Selection" - a discussion of eugenics and the possibility of a prenatal test for autism

"The Infamous 166" - a closer look at the autism-prevalence statistics

"A Tall Tale - and about to Topple" - a detailed explanation of one of the more sophisticated autism-as-mercury-poisoning conjectures

"Indistinguishable From Their Peers" and "Review: Behavior Therapy for Children with ASD" - critiques of existing literature on ABA

We'll miss you, Alyric. The blogosphere is poorer without you.

Criticism by Armchair Diagnosis

In the past month or so, I've come across two very similar instances of literary criticism in which the critic invokes "autism" to characterize strains of alienation and misanthropy in an author's body of work.

The first such usage I encountered was in a recent article in Raritan by Cambridge professor Andy Martin, titled "Autism, Empathy and Existentialism," which posited that French existentialists Jean-Paul Sartre and Albert Camus represented opposite extremes of alienation and empathy:

One way of understanding the difference between the two thinkers is to see them as occupying different ends of a spectrum with autism at one end and empathy at the other.
...
Camus manages to find much to identify with in Sartre, a sense of common ground: "Even in the most well-constructed lives, there always arrives a moment in which all the facades collapse. ... This feeling is common to us. ... As a result of going against the tide, a sense of loathing, a feeling of revolt, takes possession of our entire being, and the revolt of the body is what we call nausea." What they have in common is, paradoxically, the same thing that divides them from each other and even from themselves --- a sense of the unbearable lightness of being, pitting the individual against an interpretive community in a standoff that Camus would eventually evoke with the word "absurdity." It is characteristic of Camus that he derives some glimmer of empathy out of what can be understood as an extreme form of "social autism."

... [I]t is characteristic of Sartre that he takes Camus to pieces to see how his text works. In particular, he homes in on the use of the "passé-composé" --- what we tend to call the "perfect" --- tense. ... [T]he fact that the "composed past," consisting of an auxiliary (either être or avoir) plus a past participle can, in effect, be decomposed, seen as a bundle of disconnected pieces, appears to Sartre as the key to understanding the book: the world is just like that --- a miscellaneous collection of things that don't really fit together to make anything meaningful. It is not a plenitude but a series of gaps and voids, which we have tenuously stitched together. Camus, reading Sartre, asks himself: what does Sartre have in mind, and, by extension, what do we all have in mind, "at the limits of conscious thought"? Sartre, on the other hand, asks himself: what tense is he using?

The second instance (though it was written well before the first; I just encountered them in this order) of this literary use of autism-as-metaphor was a paraphrase of Simone de Beauvoir's "Must We Burn Sade?" in Andrea Dworkin's Pornography: Men Possessing Women.

In her essay on the Marquis de Sade, Simone de Beauvoir describes Sade's sexuality as autistic. Her use of the word is figurative, since an autistic child does not require an object of violence outside himself (most autistic children are male). Male power expressed in pornography is autistic as de Beauvoir uses the word in reference to Sade: it is violent and self-obsessed; no perception of another being ever modifies its behavior or persuades it to abandon violence as a form of self-pleasuring.

Both writers, de Beauvoir and Martin (and, to some extent, Dworkin too), are using "autism" and "autistic" to describe a worldview in which everything one encounters is either self or object.

Martin, in particular, is making explicit use of Simon Baron-Cohen's earlier "mindblindness" model of autism (which he has now incorporated into a larger theory involving sex differences in the brain):

Autism, from this point of view, is a form of mindblindness, an inability to form hypotheses about others, or even to acknowledge that there is such a thing as intentionality. Whereas solipsism is a refusal to believe in the existence of others, autism allows that other people exist out there --- I can see them, I can hear them, I can smell them, and so on --- but, at the same time, I cannot recognize them as conscious beings. I can't make sense of them.

(I should point out that, throughout his essay, Martin cannot seem to decide whether Sartre is truly "mindblind," in that he is unwilling or unable to think of other people as entities, with wills, desires and thoughts of their own, or whether he is simply alienated and antagonistic, seeing other minds as inevitably hostile to his own. These are not points of view that can be held simultaneously).

I said earlier that these writers have been using "autism" to describe a worldview. That's true, although Martin and de Beauvoir/Dworkin seem to be talking about different kinds of worldviews --- the former speaks of autism almost like a philosophical school or ideology, while the latter two treat it more like a psychological or character profile. The "autism" de Beauvoir attributes to Sade is, while less precise in what it implies about Sade's beliefs or modes of thought, is just as strong a determinant of his actions as the interpersonal agnosia and alienation Martin ascribes to Sartre.

There are a number of reasons why this use of "autism" annoys me. First, there's the perpetuation of ugly, tired stereotypes about autistics --- that we are unfeeling; that we're incapable of empathy and therefore incapable of kindness, consideration, friendship or love; that we lack understanding; that we are utterly disconnected from everything around us, etc., ad nauseam.

The second reason is that this particular lens doesn't seem to have generated any fresh insights into either Sartre or Sade. Without the oh-so-trendy use of the autism label, what would these articles have said about their subjects? That Sartre liked to take things --- texts, relationships, mental states --- to pieces until nothing recognizable was left of them? That Sade's sexuality was predatory? Neither of those would be much of a newsflash to anyone with a passing familiarity with either man's writing.

Link Roundup

I have several long, unfinished, fairly involved posts backed up in my draft queue --- some have been there since February --- but I'm really not up to writing anything substantial yet.

There are, however, a number of things other people have written that really struck a chord with me recently, so I am going to point you guys toward them as well.

First, a couple of short pieces on a perennial favorite topic of mine, sex differences within autism. Mike Stanton of Action for Autism ponders the significance of autism's lower prevalence but greater severity in women and girls, and Elesia Ashkenazy discusses some of the ways in which autistic females don't fit the usual picture of what autism is, and thus are probably overlooked in diagnosis.

There's also this terrific guest post on Shakesville by Meowser, who blogs at Fat-Fu, which I discovered via Shiva's and Hexy's blogs.

In more general non-neurotypical news, Virginia Wood has an interesting and informative post about gender policing in psychiatry. (She follows it up with a discussion of why she does not consider religious-conversion-based therapies useful).

Finally, via the What Sorts of People? blog, a couple of posts about this Current Psychiatry editorial listing six predictions about what the future of psychiatry will be like. The prediction that alarmed all three bloggers is the prospect of "prodromal" diagnosis and treatment --- i.e., diagnosing a mental disorder not on the basis of symtoms but on the basis of likelihood of developing symptoms in the future.

Jonah at Alchemical Musings discusses the implication of this development that most worries me, which is its potential for use in social control:

The trend towards prodromal mental diagnoses is frightening precisely because it cedes even more power to an already cold and inhumane apparatus, which fails to listen to the voices of the people it claims to treat. The risks of preemptive discipline and prescriptive moral judgment reek of eugenics, and are simply too great and horrifying for this practice to continue. Patients are being indicted on the basis of hereditary factors, thought crimes, and innocuous deviant behavior.

Philip Dawdy at Furious Seasons takes another, equally relevant, perspective, questioning the proposed expansion of antipsychotic use to prevent potential cases of schizophrenia on the basis that antipsychotics are powerful and dangerous drugs:

[S]ome in psychiatry believe they can identify people at-risk [sic] for developing psychosis and zap them with antipsychotics and, then, they'll never develop schizophrenia. But the one big trial of this approach --- the PRIME study at Yale --- was a disaster. I wrote about it in 2006. About half the patients bailed from the study, mostly due to side effects of Zyprexa. Overall, only about one-quarter of the 60 original participants experienced psychosis, which perhaps calls into question the power of initial assessments.

Another Stage of the Intentional Communities Odyssey

You might've noticed I haven't been writing in this blog for a while.

That's because I've been in Tennessee, visiting (among other things) the Sequatchie Valley Institute near Whitwell, TN. A friend of my boyfriend's and mine is staying there to work as a gardener, and we decided to visit her and help out with some of the work they're doing, as well as attending a couple of workshops*.

Staying at SVI was a very different experience than staying at The Farm was --- for one thing, it was a very different type of environment, being on a densely forested, steep hillside rather than a flat, grassier area. (The Farm, I was told, had acquired most of its land from a defunct paper mill, and the land had been clear-cut several times during the mill's period of operation). There were also a lot fewer people there: six people living at Moonshadow, which was the part of SVI we were visiting --- there's also a house and gardens at the foot of the hill, called Sweet Gum, where a family of seven people lives --- plus the other visitors who came either for the workshops or the workday at Ulinawi. But, unlike at The Farm, the other visitors did not stay overnight, and even the people who lived there mostly seemed all to have their own, generously spaced, sleeping quarters, with people gradually filtering into the main communal building throughout the day to cook, eat, and hang out. Accordingly, I did not have to interact with people constantly, and the number of people I did see every day was a lot smaller. (Also, two of them were well-known to me, while at The Farm I was thrown together with about a dozen strangers for a very immersive, intensive experience).

Even with all that, though, I had a lot more trouble with overloading at SVI than I ever did at The Farm. I think the main reason for that is because we got there right before the busiest days --- the two workshops, when the most people would be around and the most structured activity would be going on. Also, I was pretty sick physically at the time, so it might also have been that my usual defenses were somewhat lowered.

I really liked the layout of Moonshadow, though: the one communal building with kitchen, fireplace, shower and offices, with smaller sleeping cabins scattered around it. For me, I think the ideal community has both shared spaces for cooking, eating, work and play, and also separate individual spaces to which people can retreat if they need to.

*A wildflower-identification hike and a shiitake-mushroom-growing workshop, both of which I ended up missing because I was sick.

Racial and Class Aspects of Homebirth

Via Feministing, I found this thought-provoking article by Miriam Pérez (who blogs at RH Reality Check, Feministing and Radical Doula) about additional barriers to safe, midwife/doula-assisted homebirth poor women and women of color face.

Some of those barriers are:

Lack of insurance coverage

"I work in a (very) low-income Medicaid clinic in Sacramento [California], and the women all have Medicaid or Family Pact as insurance," [Certified Professional Midwife JayVon] Muhammad explains. "Medicaid doesn't cover homebirth, so even if women choose to have homebirth, they are not covered, leaving no choice at all. As a result, when women show an interest, and very few do, they don't have a choice. They are forced (due to lack of money, and insurance) to deliver in the hospital."

Documentation worries

In recent years, particularly since 9/11, obtaining passports and other citizenship documentation has become increasingly difficult. The crackdown has focused on people born to midwives at home. Immigration authorities have begun questioning the validity of documents from these midwives and holding these individuals to a much higher burden of proof. This has had a disproportionate impact on Latinos and other immigrants, requiring them to go to great lengths to obtain passports and other documentation. [Washington, D.C. doula] Claudia Booker thinks this fear of citizenship being questioned may keep low-income people from leaving the hospital to give birth.

Lack of awareness

Doulas and midwives who work in low-income communities of color see the barriers as being social in addition to financial.
...
"My clients don't know a thing about homebirth, nor do they understand why they would even consider such a thing," explains Muhammad. "They are not educated about the benefits of birthing out of the hospital or birthing without interventions."

Experience of homebirth as something done because there was no other choice

Claudia Booker ... explains that women in low-income communities of color stopped giving birth outside of hospitals at least three generations ago. There is also a sense, she noted, that giving birth at home is "what poor people do and [that homebirth] was something we did because we had no option." This history reflects a larger transition among US women giving birth at home to hospital birth, which happened in the 1920s. Low-income communities, and particularly African-American ones, took longer to make this transition because of poverty, racism and lack of access to hospitals.

While for well-off white women, giving birth at home might sound like a way to take control over one's own pregnancy and delivery, and secure more choices, to poor women of color it could just as easily look like a loss of those choices they have only recently gained.

As one of the commenters points out, this reflects a "two-tiered system of giving birth in America." Of course, our entire health-care system is multi-tiered, with only the top tier providing anywhere near the level of care people need.

Read the whole thing!

Somali Autism-Cluster Scare Has Worrisome Fallout

In my last post, I focused on the technical details of disease clusters, how they are studied, and the particulars of the autism clusters in Stockholm and Minneapolis. Now, with this post, I'd like to concentrate on some of the more human aspects of these stories.

Autism is not very well-understood by anybody, but it's an especially foreign concept to a lot of the Somali immigrant families profiled in the news stories.

[M]any Somali parents are baffled and scared.

"It's beyond denial," said Hassan Samantar, a parent advocate at the Pacer Center for disabled children. "There was no word for this in Somali. We've seen Down syndrome and schizophrenia, but loosely termed --- our word is more like 'crazy.' People are calling it 'otismo' or 'the American disease.' And some are saying it's something you did or something your parents did, and the curse is catching up with you."

Many Somali parents here do not read English or watch American television, he said, so they first hear of autism only when a pediatrician suggests testing a child.

Because neither autism in general nor the unusually high prevalence of autism in some immigrant communities has yet been very well explained --- there are many competing, potentially overlapping hypotheses of how autism develops, with only part of the picture filled in with any confidence --- there's a gap in the public discourse about autism that certain less-than-scrupulous parties are eager to step in and fill.

Antivaccine activists are campaigning among [Somali immigrants in Minneapolis], which worries public health officials, especially because some families go back and forth to Somalia, where measles is still a significant cause of childhood death, according to Unicef.
...
In November, J. B. Handley, a founder of Generation Rescue, which advocates treating autistic children with wheat- and dairy-free diets, vitamins and chelation to remove mercury, wrote an open letter to "Courageous Somali Parents."

He warned them not to trust the state health department and suggested they slow down their children's shots and get exemptions to school vaccination requirements. He also offered to pay for some to attend an antivaccine conference.

The appeal has had an effect. Many parents, including Ayub's, now say their children's autism began after seizures that started after they got shots.

(As an aside, I'd like to point out how misleading it is for the Times to list a highly dangerous procedure like chelation alongside relatively benign alternative therapies like vitamins and special diets. Vitamins and special diets might not do much, but people don't die from them).

Fear of vaccination is also growing more common among Somalis in Stockholm:

Idiopathic autism is a challenging condition for parents. Along with genetic aspects, several other explanations have been discussed, including the influence of diet, intestinal inflammation, and vaccination. In a geographical area of Stockholm, with a relatively large Somali immigrant population, many parents of Somali children have refrained from letting their child be given the measles, mumps and rubella (MMR) vaccine because of the controversial (and now refuted) link between MMR vaccination and autism. In that specific area of Stockholm, vaccination frequency was 69.5% in 2005, and 71% in 2006, in comparison to about 95% in most other areas in Stockholm. In this area in the northwestern part of Stockholm, parental concern about the risk of vaccination coincides with concerns from teachers and autism assessment teams about a seemingly higher than expected proportion of Somali children having autism.

(Quoted from the Introduction of Barnevik-Olsson, Gillberg and Fernell, 2008).

While the solitary crank who refuses to vaccinate has been annoying people as long as vaccines have existed, it's more worrying when groups of people refuse to vaccinate. For one person, or a few who are isolated from each other, they can at least get by with herd immunity and never even come into contact with the pathogen. But if you have an enclave of people without immunity, you run the risk that the disease might become endemic among them.

These Somali immigrant communities are at an additional risk because of the frequency of trips made to and from Somalia, where measles is still common.

In a climate of fear, people look for certainty. The lack of clear, easy answers about autism from the scientific community has driven many of the more fearful parents into the arms of people who do have easy answers, even when those answers are false and potentially very dangerous.

Both the purveyors of deceptively simple answers and those in the media who create that climate of fear are wrong.

Autism in Somali Immigrant Communities: Epidemic, Coincidence or Genetic Pattern?

EXECUTIVE SUMMARY: Health-care and special-education professionals in the city of Minneapolis, Minnesota are noticing what they think is an unusually high proportion of severely autistic children within Minneapolis's Somali immigrant community. The Minnesota Department of Health is looking into it, trying to determine whether there really is a higher rate of autism prevalence among Somalis in Minneapolis.

A similar study was done last year in Sweden, looking at autism prevalence among Somali immigrants in Stockholm. While that study did find an elevated rate of diagnosed ASDs among Somali children, the group of Somali children with autism diagnoses was so small (seventeen individuals) that the finding of increased autism prevalence should not be taken very seriously.

Both the Swedish study and the planned Minnesota study involve looking at special-education statistics for their estimates of how many children --- both in the general population and within the Somali immigrant population --- have autism diagnoses. There are several problems with these data, particularly in Minneapolis, whose autism programs are open to all Minnesotans and thus can be expected to draw people from all over the state.
_____________________________________________

Via the What Sorts of People? blog, I found this New York Times article about a possible "autism cluster" in the Somali community of Minneapolis, Minnesota.

What is an autism cluster?

A "cluster" is an unusual aggregation, real or perceived, of health events that are grouped together in time and space and that is reported to a public health department (CDC 1990). Several breakthroughs and triumphs in infectious disease control have resulted from the epidemiologic evaluation of clusters of cases.
...
Investigations of noninfectious disease clusters have also resulted in notable examples of breakthroughs linking a particular health effect to an exposure, such as angiosarcoma among vinyl chloride workers (Waxweiler et al. 1976), neurotoxicity and infertility among kepone workers (Cannon et al. 1978), dermatitis and skin cancer among people wearing radioactively contaminated gold rings (Baptiste et al. 1984), adenocarcinoma of the vagina and maternal consumption of diethylstilbestrol (Herbst et al. 1971) and phocomelia and consumption of thalidomide (McBride 1961).

Whenever a cluster of a noninfectious disease occurs, questions arise as to what could have caused it:

While there is little research on autism clusters, reports of cancer clusters are so common that health agencies across the country respond to more than 1,000 inquiries about suspected ones each year. A vast majority prove unfounded, and even when one is confirmed, the cause is seldom ascertained, as it was for Kaposi's sarcoma among gay men and mesothelioma among asbestos workers [or any of the conditions listed in the above quotation].

It is "extraordinarily difficult" to separate chance clusters from those in which everyone was exposed to the same carcinogen, said Dr. Michael J. Thun, the American Cancer Society's vice president for epidemiology.

Since the cause of autism is unknown, the authorities in Minnesota say it is hard to know even what to investigate.

According to the "Autism and the Somali Community" page on the Minnesota Department of Health website, the MDH is currently analyzing data on Somali children in the Minneapolis Autism Program, and will release a report on its findings on April 1*.

Until then, we've still got a similar study of the prevalence of autism in the children of Somali immigrants in Stockholm, Sweden. The methods this study's authors (Dr. Martina Barnevik-Olsson, Dr. Christopher Gillberg** and Dr. Elisabeth Fernell) used were quite similar: as the MDH plans to do, Olsson, Gillberg and Fernell reviewed records of all Somali children (either Somali-born, or children of Somali-born parent/s) diagnosed with an autism spectrum disorder and enrolled in autism support programs, determining the prevalence of autism both within the Somali community and in the larger city, and also trying to identify any common factors in the children's medical histories.

The Swedish study did find an elevated prevalence rate among the Somalis of Stockholm: Somali children were about three or four times as likely as non-Somali children to have a diagnosis of autism or PDD-NOS. (Prevalence rates for these groups were 0.7% and 0.19%, respectively).

Unfortunately, the group of Somali children diagnosed with an ASD was made up of only seventeen people. Those seventeen, as a percentage of the 2,437 Somali children living in Stockholm, represented a bigger chunk of their demographic than the 484 autistic children not of Somali descent did, but with smaller numbers percentages get less reliable.

The study's authors acknowledge this, and also one other potential weakness of their study's design (one the Minneapolis study will probably share):

One limitation of this study is the retrospective collection of data, relying on clinical notes that had not been intended for research. Only the autistic disorder or PDDNOS diagnoses for the Somali children were checked and reconfirmed. The data are therefore not complete and must be seen as preliminary.

There were some interesting things they found out, however preliminary and unconfirmed:

Our clinical impression is that this group of Somali children constitutes a rather homogeneous group in the autism spectrum with regard to four characteristics: (1) the age at which the developmental deviation was noted (12-24 mo.); (2) the presence of a definite intellectual impairment in all 17 individuals, mostly of a moderate to severe degree; (3) the fact that motor function was not impaired, except in one child; and (4) the fact that the activity level was exceptionally raised in the vast majority of the children.
...
All individuals had learning disability. This is a developmental disorder in which genetic background factors have a prominent role. Recessive inheritance has been especially demonstrated in severe learning disability. In many parts of the world, especially the Islamic countries[***], marriages between close relatives are common. In a previous study from Stockholm county, covering a population with a high rate of non-European/non-North American immigrants, the prevalence of severe learning disability was found to be 3.7 and 5.9 per 1,000 respectively, in the European and in the non-European population.

The clinical profile shared by the seventeen Somali children in the Swedish study --- particularly the predominance of learning disability and intellectual impairment --- also seems to show up in the Minnesotan children.

From a MinnPost.com article:

About a quarter of all autism [sic] children who attend autism classrooms for students functioning too low to be mainstreamed in regular schoolrooms are Somali. Special education specialists said that indicates that the degree of autism Somali children are developing is on the severe end of the autism spectrum.

"I'm not seeing Aspergers syndrome and the full spectrum of autism in Somali children. It is the more classic forms of autism in general; it is the more severe forms of autism that we're seeing in our Somali babies that are born here," said Anne Harrington, early childhood special education coordinator for the Minneapolis district and a specialist on the topic.

And from the Times story:

In the last decade, [Harrington] said, "we've begun seeing a tremendous number of kids born here who have the most severe forms of autism."
...
"They had classic symptoms," [pediatrician Dr. Daniel S. McLellan] said. "Really impaired language, didn't watch faces, didn't make eye contact, didn't communicate with gestures, just lost in their own worlds. Nobody would mistake it for anything else."

While the Minneapolis Somali community is likely to be larger than its Stockholm counterpart (a conservative estimate from the State of Minnesota puts the number of Somalis living in the state at 14,000-15,000, with most of them living in Minneapolis), there are some other problems likely to emerge with the special-education statistics.

From a news story published last September by the Simons Foundation Autism Research Initiative:

Epidemiologists are generally skeptical of disease clusters, and this one is no exception.

"Those numbers [referring to an earlier finding that Somali children make up 6% of Minneapolis schoolchildren and 17% of its special-ed students designated autistic] are strikingly different, but it's not really an appropriate comparison," says Judy Punyko, an epidemiologist at the Minnesota Department of Health.

The Minneapolis statistics include only children from certain age groups and only those attending public schools, Punyko notes. What's more, Minneapolis autism programs have an open-enrollment policy, meaning they often accept children from other school districts, potentially skewing the prevalence numbers for the district. "I want to get the real numbers and understand these numbers before we move on," Punyko says.

In August, Punyko created a study group of 12 experts --- including epidemiologists, physicians, school administrators and special education teachers --- to compare the autism prevalence across all Somali children in the city with age-matched controls.

Even then, she adds, educational data may be incomplete or inaccurate. The 13 special-education categories reported to the state and federal government are intended to help provide a child with the best available educational services. If a child has two conditions, such as autism and developmental delay, they can only be assigned to one primary category; Minnesota does not require a medical diagnosis of autism to be included in the category. Finally, some schools, especially those in the poorer districts, often overlook milder forms of autism.

So, like the Swedish researchers, the Minneapolis researchers will have to deal with data that probably weren't collected with the same level of rigor they'd normally use to collect epidemiological data. I also suspect that those poorer school districts probably house a lot of Somali immigrant families, which, given the tendency of those districts not to notice "milder" autism, would make the above-cited observation about Somali "clusters" having a disproportionate share of severely autistic children a self-fulfilling prophecy.

*Yes, April Fool's Day. I don't think there's much of a chance of this being a big practical joke, but I am always a bit leery of papers published on April Fool's Day.

**Gillberg's name was already familiar to me, as he's done a lot in the field of autism research, but one thing I hadn't known before Googling him was that he'd proposed a set of diagnostic criteria for Asperger syndrome. They're not the criteria the DSM currently uses, but apparently they're quite faithful to Asperger's original descriptions.

***I'm going to interject here that "the Islamic countries" is a very unhelpful geographic category. Is he aware of just how many countries, in how many different parts of the world, have a lot of Muslims in them? It makes about as much sense as talking about "the Christian countries" --- you could be speaking of Europe, Australia, the Phillippines, Central America, South America, North America, and also large swathes of south and central Africa! Similarly, "the Islamic countries" include huge areas of Asia (all of the Middle East, and much of south and central Asia), Africa, parts of Europe, and Indonesia.

Barnevik-Olsson M, Gillberg C, & Fernell E (2008). Prevalence of autism in children born to Somali parents living in Sweden: a brief report. Developmental medicine and child neurology, 50 (8), 598-601 PMID: 18754897

This Is Cool

Apparently the Coterie Theatre (a children's theater in Kansas City) is putting on a play about a character who is different from other children and, try as he might, can't quite fit in.

From the "Resource Guide" on the play's webpage:

From the playwright: "Atypical Boy is a cautionary tale of a world that presents a comic anti-model of behavior. It is not intended to be realistic." The title character lives in a far away land where conformity is compulsory. Boy cannot conform. Others make desperately silly attempts to fix him, but neither they nor he can change his differences.

Labeled a "monster" by the others, Boy finds himself alone and disenfranchised in a world filled with monsters. In his exile Boy clashes with Hugo, ruled by his outrageous monster side, and is drawn to Girl, who struggles to remain human. At a point near the end of the play, the action will stop at the most unresolved point, and a 10 to 15 minute interactive forum will take place. At this point the audience can give the stage characters advice.

This Playbill News story reveals that Atypical Boy was commissioned by the Jim Eisenreich Foundation for Children with Tourette Syndrome, with the idea that it might help raise awareness of "complex issues concerning people living with invisible disabilities":

"While Atypical Boy does not mention TS or any specific disability, it uniquely addresses issues about acceptance, how we treat others, and forming relationships in an entertaining and thought provoking manner," said Jim Eisenreich, foundation founder and former Major League baseball player. "My hope is that every person who attends the play, whether they have a condition like TS or not, considers how our actions and words can both hurt and heal."

Though the play sticks to general themes, I did spot a few things in the stories I read about it (I haven't seen it yet --- I would like to, since it looks really neat, but it's hard for me to get into Kansas City proper, since I live way out in the suburbs, don't drive, and am loth to take up three or four hours of my parents' time just to ferry me out to see a play) that I thought had special significance to autistic self-advocates.

First, there's this:

(Image taken from this review in the Kansas City Star).

In this scene, Boy is taken to a Behavioral Intervention Center and shocked in an effort to make him normal. Both the use of electroshock and the use of the phrase "behavioral intervention" call up autism-specific associations: the Judge Rotenberg Center in Massachusetts, where each student (many, but not all, of whom are autistic) is outfitted with a backpack-like device that will zap them whenever a staff member presses a button; early experiments using shock (and other "aversives," such as yelling, slapping, shaking or restraint) to try to train autistic children to act normal.

Another thing autistics may find particularly familiar is the metamorphosis of some characters into monsters. Boy gets labeled a monster, and in his travels he meets a real monster who used to be human. Boy has to choose whether he will become a monster, too, or stay human despite being called a monster.

One thing I wonder is, why does only the monster have a name? He's named Hugo, while Boy and Girl are not named. That's interesting to me --- I can see that, in the world of the play, any expression of individuality --- of difference from others --- is monstrous; maybe the name is part of that. Embrace the monster, become too far removed from your fellow humans, such that you are no longer even one of them, and you become a perfect individual. You're the only thing walking around that looks, talks, or feels like you, so you're no longer a human, you're a (your name).

Anyway, that's that.

Atypical Boy will be performed at the Coterie March 10 through March 29, every day but Monday. Its Coterie run is the world premiere; maybe in a few seasons it will come to other cities in the US, too. It definitely sounds like a fun, interesting thing for autistic (or otherwise neurodiverse) families to go to; I'd urge Kansas City area parents to check it out!

Oh No, An Analogy!!

While drafting my epic-length response to Jonathan Mitchell's comment on this post, an analogy occurred to me.

First, some context.

Jonathan wrote:

Autism is still a disability that prevents people from being able to talk, causes them to smear feces on walls and be totally dysfunctional in its most severe cases. Trying to make the glass half full by describing it as a different form of brain wiring rather than a disease indeed does not change the contents of the glass. It is still a bad thing that needs to be cured no matter how much phoney baloney spin you and the rest of the ND put upon it and try to make a glass half full.

I responded (in part):

...I do not think the idea of a cure for autism is anything more than a colossal blind alley. I strongly doubt its possibility, for one thing, given how many different genes have been shown to play a role in its heredity, and the tiny share of all cases of autism each gene is found to explain; and for another, I think it's ridiculous to try to engineer away an entire category of people on the grounds that *SOME* of those people lead miserable lives for reasons that might be partially attributable to their genetic makeup.

As I was writing that, it occurred to me that there does exist a category of human being that, however internally heterogeneous it may be, differs from what is often held up as the default, "typical" human being in a lot of ways, and whose overall failure to thrive in comparison with the default group is often blamed on this other group's tricky psychological and physiological differences. Yet, despite this group's disability, no serious person would ever suggest curing them of their chromosomal condition*.

Who are these people? Why, they're women!

Compared to men, women are much more likely to have certain psychiatric disorders (e.g., anxiety and depression), less likely to be working, more likely to be working an unrewarding, low-paying menial service job, and much, much more likely to be poor. They are also more likely than men to engage in self-injurious behavior or attempt suicide, although men succeed in killing themselves much more often than women do.

Most people's** first impulse is not to blame all of these things on any inherent physical or psychological feature of womanhood, however.

Even when there might be innate physiological factors that work to women's disadvantage, though --- our seriously inconvenient reproductive biology springs to mind, as does the possibility of sex differences in brain chemistry contributing to women's greater share of mood disorders --- nobody uses that to argue that femaleness itself is a pathological condition that should be cured!

That's as it should be, and also as it should be for autism.

EDIT: It turns out this analogy has been made before --- by Joseph, back in 2006! His post is a lot funnier than mine, too.

*Yes, this statement is a bit problematic, in that it glosses over the extent to which womanhood has been, and still is, pathologized. There is a significant difference, however, between the way women are pathologized and the way autistics are pathologized: certain aspects of women's lives --- menstruation, pregnancy, menopause --- might be medicalized, but every aspect of autistic people's lives, up to and including the mere fact that we exist, is seen as a major medical crisis to be stopped. I feel reasonably certain that, if someone were to call all women diseased, and call for a cure that would turn them into men, almost everybody would consider that person crazy. And that's the important thing for this analogy.

**I am optimistically excluding antifeminists from "most people" here. I do think that, while most people might indeed be mistaken about the extent to which sexism exists in the industrialized West, they are usually willing to grant that women in other parts of the world have it pretty bad, above and beyond what men in poorer countries experience.

Autism, Neurodiversity and Self-Esteem

Joseph of Natural Variation has an intriguing post up about differences between autistics who think of their autism in neutral, mixed or positive terms* --- and who therefore tend to think of it as a difference to be accommodated rather than a disease to be overcome or cured --- versus those who see their autism only in terms of difficulties, and wish they were not autistic.

Joseph's post was a response to this post by Jonathan Mitchell of Autism's Gadfly, which cited this article in the journal Dyslexia (Joseph provided a link to this annotated Powerpoint presentation on the same research) on the BRAIN.HE project, which interviewed 27 neurodiverse college students about their attitudes and experiences.

From the abstract:

Participants generally held one of two views about their identity as "neurodiverse": a "difference" view --- where neurodiversity was seen as a difference incorporating a set of strengths and weaknesses, or a "medical/deficit" view --- where neurodiversity was seen as a disadvantageous medical condition. The former view was associated with expressions of greater career ambition and academic self-esteem, while the latter view was associated more with processes for obtaining the Disabled Students' Allowance.

While Jonathan Mitchell attributes the rosier outlook of the students who thought of themselves as "different" rather than "broken" or "damaged" to the former group's having fewer objective challenges than the latter, Joseph suggests that the difference might lie entirely in the two groups' worldviews. If you know your mind works differently from most people's, it makes sense that your appraisal of your own abilities and potential will vary with the value you assign to those differences. If you see them all as pathological, and yourself as something less than a whole person, of course you won't think much of your chances for future success and happiness. At the same time, if you see yourself as having special gifts to offset your difficulties, you'll probably be more optimistic, both about your future and about your present accomplishments.

The report itself doesn't give enough information to rule out either of those possibilities. In terms of methods, this was a qualitative rather than quantitative kind of study, and thus most of its "data" were in the form of common themes emerging from the students' life stories. As the focus of the report was on the students' attitudes and experiences, rather than on academic or life outcomes, there was no information given about the students' relative aptitudes, "functional levels" or whether these correlated in any way with self-esteem or beliefs about neurodiversity.

The researchers tracked four things: students' view of neurodiversity (which they split into two categories, "Difference/Strengths" and "Medical/Deficit"); students' experience, if any, of being called names (like "stupid" or "lazy") by unsympathetic teachers; students' "academic self-esteem" (which I imagine means how good a student you think you are); and students' plans for the future (which fell into three categories, Ambitious, Uncertain and Negative, or various combinations of those). They found that most of the students who viewed themselves in terms of the medical model of disability, with its focus on deficits, were uncertain or pessimistic about their futures and more likely to have low academic self-esteem.

13 of the participants viewed their neurodiversity as an entirely negative matter. These participants frequently used negative or medical terminology[**] when talking about their labels which indicated that they felt in some way broken or damaged. Of the 13 students who had this view, 8 indicated low academic self-esteem and expressed confusion and uncertainty about their future plans.

As Joseph says, these findings could be explained just as well by either hypothesis. The less-optimistic students could just be less gifted, and their pessimism a realistic appraisal of their likely prospects. They could just as easily be pessimistic because they have learned to see themselves in a pessimistic light.

While nothing in the study clearly supports one hypothesis over the other, I did see something that cast just a little bit of doubt on the contention that the more confident, optimistic students are objectively smarter or better adapted than the gloomier ones: Almost every student (six out of seven) who had been called unflattering names by a teacher went on to develop a difference- or strength-based view of hirself (rather than a deficit-based one), and most of them (five out of six) had good academic self-esteem and half of them (three out of six, with two of the remaining three not answering the question) saw themselves having bright futures. This group of students also represented more than half (six out of eleven) of the Difference/Strength group. Clearly, the Difference/Strength group cannot be so brilliantly high-functioning as to have sailed through their earlier schooling without a hitch, if so many of them have been singled out for individual denunciation by various teachers.

The researchers explain this by invoking the students' determination. When their teachers antagonize them, the students become motivated to prove the teachers wrong.

This post has already gotten long, so I will end here for now. I would like to look at some of the literature on self-esteem, though, to see if I can't throw some light on what factors do and don't influence it. Ideally, I could also dig up some specific research into self-esteem in autism, though so far I haven't found any such articles. I would, even speaking from a position of total ignorance so far, be willing to hypothesize that different factors influence self-esteem in autistic people than in NTs.

*Miss Gonzo Galore pointed out in comments that it is misleading to speak of "pro-" or "anti-neurodiversity," as most autistics have probably not politicized the issue. I think this is quite likely true, and thus have used a somewhat more broad-based framing terminology.

**As a side note, I think I should point out that just using "negative or medical terminology" to talk about one's neurological wiring doesn't have to imply any particular attitude toward that wiring. It could just reflect how one has learned to talk about one's differences, which are often very hard to articulate. I will often use both medical terminology *AND* "negative" phrasing (as in, "I don't do X" or "I completely lack Y") because 1) the medical term for a thing is often the first --- or only --- name I've ever seen for that thing, and it's easier to name something than to describe it; and 2) when describing how my mind works to NTs, I often find it's easiest to start by telling them what their minds do that mine doesn't do. From there, I can move on to what I do instead.

Edward Griffin, David Pollak (2009). Student experiences of neurodiversity in higher education: insights from the BRAINHE project Dyslexia, 15 (1), 23-41 DOI: 10.1002/dys.383

I Am Literal-Minded

The vast, vast majority of paintings I do, I do from life --- and often the subject matter will be dictated by what's in front of my face when I get the urge to draw something.

Exhibit A:

These paintings were actually an art-class assignment: for some reason (maybe to test our color-mixing ability?) the teacher spread out a bunch of crayons on the table and told us to paint them.

Now, this wasn't assigned. The painting below is of a subject I freely chose.

Yes, it is the first thing that caught my eye. It was painted with those very same paints, too! How's that for recursion?

Did I mention I'm literal-minded?

More Hilarious Zeitgeistiness

Yes, I did say I had two wacky 1930s book ads to show you. You're not going crazy. It's just that I ended up spending a lot more verbiage than I had planned for (as usual) on the first one, so I thought I would break it up into two posts.

Here's other one, from the same magazine:

This time, the book being hawked is titled "STRANGE LOVES: A Study in Sexual Abnormalities." For sophisticated adult readers only, which is a slightly stricter criterion than "Sex Harmony and Eugenics" came with --- that one, they only would not ship to children. No sophistication required, as long as you were of legal age.

I am sorry I wasted the word "purple" on the copy describing "Sex Harmony and Eugenics," when it's now clear to me that that writing couldn't hold a candle to what's in this ad.

(I'd adjust my appraisal, and say that the copy in the earlier ad was merely "lavender," if that word with its more recent historical connotations were not so perfect for this ad).

Examples:

For hundreds of years men and women have talked with hushed voices about "STRANGE PEOPLE" --- men who are not men --- women who are not women. No one has ever dared to talk out in the open about THE THIRD SEX. Is it any wonder that the shocking lurid facts of this great social evil are unknown to the great mass of men and women?

The terms used here, besides being more reminiscent of a carnival barker's spiel than an academic or medical treatise (that's another thing about these old ads --- get a load of the absolute authority given to doctors!), are very confusing. Sometimes the copy seems to refer to gay men and lesbians, sometimes to intersexed people, sometimes to transpeople, and sometimes merely to men or women who do not act sufficiently masculine or feminine.

I imagine that in the author's fevered imagination, these categories overlap one another considerably.

Now a Doctor has dared to tear away the veil of mystery that hides the facts behind homosexuality. In blunt understandable words he describes the unbelievable facts. "STRANGE LOVES: A Study in Sexual Abnormalities," by Dr. La Forest Potter, noted authority, is a document so weird, so startling, as to amaze the civilized world. Dr. Potter says, "NO MAN ON EARTH HAS A CHANCE AGAINST A WOMAN ONCE SHE HAS SUCCUMBED TO ANOTHER WOMAN." A startling, provocative indictment against the false modesty that has been responsible for the growth of these fantastic strange amatory curiosities among savage and civilized races.

Look, there's false modesty again! This is an interesting aspect of early 20th-century American culture, with its pop Freudianism and its emphases on hygiene and on scientific homemaking and childrearing. The same deep fear and loathing of sex (and of women in general) still lurks underneath the modernized surface; it's just that, now, sex outside of procreative sex within marriage isn't sinful so much as unhealthy.

It's a bit dizzying to consider how the blame for "deviant" sexual practices has shifted over the centuries. You've got the medieval conception of woman as sensual, easily tempted Eve whose insatiable sexual appetite had to be carefully safeguarded by her father and husband; you've got the Victorian "angel in the house" who is ethereal, unworldly and entirely asexual, but whose duty it is to provide her husband (who is now the insatiable animal but, curiously, is not subject to strict control by the women in his life) with a suitable sexual outlet, lest he fall in with Bad Women who will lead him into utter dissolution; and now, with this hygienic, pop-Freudian conception of sex, it is repression of normal sexual development which leads to morbid fascination and unusual appetites.

(On a sillier note, I absolutely love the all-caps "NO MAN on EARTH has a CHANCE against a woman" --- why against? shouldn't it be with? --- "once she has succumbed to ANOTHER WOMAN!" I love the idea that lesbians are lurking out there in some dingy opium den or back alley, waiting to tempt some innocent straight girl from the path.)

Wacky Magazine Ads from 1934

While perusing some old pulp magazines from the 1930s, mostly of the true-crime variety, I ran across a couple of ads that stopped me right in my tracks with their hilarious zeitgeistiness.

They were both for books; books which I imagine have vanished in the mists of time.

First, this one, for what seems to be a sex book of the "marriage manual" subtype:

Notice the title of the book: "Sex Harmony and Eugenics."

(You can find a clearer image of an ad for the same book, with some of the same text, on the last page of this reprint of a 1937 "Modern Mechanix" article. One thing that differs between the two is the identity of the book you get for free with your order of "Sex Harmony and Eugenics" --- in the ad pictured above, you get "Why Birth Control?", while in the ad from "Modern Mechanix" you are offered the expansively titled "Philosophy of LIFE," which is described as a frank discussion of "the difference in construction and function of man and woman.")

The above ad, besides astonishing me with "Eugenics" as apparently part and parcel of the sex ed of its day, also amused me with its purple prose about "The Forbidden Secrets of Sex" and the alternately swoony and disapproving faces in the accompanying photo.

Some samples:

Away with false modesty! At last a famous doctor has told all the secrets of sex in frank, daring language. No prudish beating around the bush, no veiled hints, but TRUTH, blazing through 576 pages of straightforward facts.

Some will be offended by the amazing frankness of this book and its vivid illustrations, but the world has no longer any use for prudery and false modesty.

Lost love ... scandal ... divorce ... can often be prevented by knowledge. Only the ignorant pay the awful penalties of wrong sex practices. Read the facts, clearly, startlingly told ... study these illustrations and grope in darkness no longer.

(Hee hee. "Grope in darkness" --- there's a double entendre for you!)

There are also two (separate, of course) lists of what the author thinks "EVERY MAN SHOULD KNOW" and "EVERY WOMAN SHOULD KNOW." The men's list features such items as The Sexual Embrace, Secrets of the Honeymoon, How to Regain Virility, Glands and the Sex Instinct, and Sexual Starvation, while the women's list includes How to Attract and Hold Men, Intimate Feminine Hygiene, a Birth Control Chart, What to Allow a Lover to Do, and the requisite horror stories on Prostitution and Sexual Slavery of Women. In other words, men learn how to perform sexually (and, with the chapters on "sexual starvation" and regaining "virility," they learn that they are expected to perform sexually, whenever presented with the opportunity) while women learn that they are to be sexual gatekeepers, "allowing" lovers to do only what Good Girls Do, and shouldering all the responsibility for birth control and proper mate selection while making sure to stay attractive and receptive enough to hold the man's interest.

I was able to find pages from this book on the Eugenics Archive website, and I think this image taken from there illustrates perfectly the book's attitude toward women's sexuality:

The woman who is truly educated about sex, y'see, doesn't endeavor to find out anything for herself, by reading novels or erotica or seeking out sexual experiences. No, she is content to let her mother tell her everything she needs to know, and to remain a virgin until marriage and then dutifully have procreative sex with her eugenically-approved husband.

Good to know that, then as now, talk of liberated, informed sexuality is really only meant to apply to one gender.

Is There an Extreme Female Brain?

That question came up in the comments on this post I wrote in September on Simon Baron-Cohen's Extreme Male Brain theory of autism.

While Baron-Cohen did describe the Type E, or "female," brain in the lengthy paper I discussed in the earlier post, nowhere in that paper did he mention an extreme version of this type analogous to the "extreme male brain" he posits as an explanation of autism.

However, in his book-length treatment of the larger subject of brain sex in general, The Essential Difference (2003 --- brief summary and critique available here), he devotes a whole chapter to the extreme female brain.

Baron-Cohen claims that extreme empathizers have been harder for him to characterize because he hasn't seen any of them in his clinic. He hypothesizes that because it's easier for people who are highly skilled at dealing with people but who are helpless at solving problems and thinking logically to function in society, such people do not generally present their cases for psychologists' perusal.

All scientists know about the extreme female brain is that it is predicted to arise ... Scientists have never got up close to these individuals. It is a bit like positing the existence of a new animal on theoretical grounds, and then setting out to discover if it is really found in nature.
...
[W]hat would such people look like?

... Their empathizing ability would be average or significantly better than that of other people in the general population, but their systemizing would be impaired. So these would be people who have difficulty understanding math or physics or machines or chemistry, as systems. But they could be extremely accurate at tuning in to others' feelings and thoughts.

Would such a profile carry any necessary disability? Hyperempathizing could be a great asset, and poor systemizing may not be too crippling. It is possible that the extreme female brain is not seen in clinics because it is not maladaptive.

We saw that those with the extreme male brain do experience a disability, but only when the person is expected to be socially able. Remove this expectation, and the person can flourish. Unfortunately, in our society this social expectation is pervasive: at school, in the workplace and in the home. So it is hard to avoid.

But for those with the extreme female brain, the disability might only show up in circumstances where the person is expected to be systematic or technical. The person with the extreme female brain would be system-blind. Fortunately, in our society there is considerable tolerance for such individuals. For example, if you were a child who was systemblind, your teachers might simply allow you to drop mathematics and science at the earliest possible stage, and encourage you to pursue your stronger subjects. If you were a systemblind adult and your car didn't work, you could just call the mechanic (who is likely to be at least a Type S). If your computer needs putting together, and you can't work out which lead goes into which socket, there are phone numbers that you can ring for technical support. And in evolutionary terms, there were likely equivalent people that a systemblind person could turn to for help when that person's home was destroyed in strong winds, or when their spear broke.

Despite the silliness of the idea of Prehistoric Tech Support ("Step One: Does Your Spear Have a Pointy End?"), Baron-Cohen has a good point here: with the increasing complexity of society, technology and daily life, division of labor has proceeded to such an extent that many different categories of people exist whose job it is to make sure other people's gadgets are functioning as they should. The need to repair one's own stuff has gotten less and less --- and rich people have never had to fix their own broken appliances --- and, indeed, is no longer possible for many electronic gadgets. Since these extreme Type E's would be good at navigating complex social networks, they should have no trouble knowing whom to consult about what annoying technological hiccup.

That's about as far as I'm willing to grant that his prediction holds any water, though. I think he dramatically underestimates the degree to which systematic modes of thought are needed in modern life. In one example, he has his hypothetical extreme empathizer dealing with a car that won't start; were I in the room when he was writing that part, I would ask him what business he has supposing that this systemblind person could even drive a car? Driving requires memorization and application of a very specific and complicated set of rules, deriving other vehicles' likely trajectories from those rules, and performing fairly complex feats of spatial reasoning quickly and often. All of these things, you have probably realized, are examples of the "systemizing" cognitive style that these extreme Type E's are supposed to lack.

Later in the chapter, Baron-Cohen considers some of the possible matches for his extreme female brain among existing psychological disorders. He rejects what I had thought to be the obvious choice --- paranoia --- on the grounds that the over-attribution of hostile intentions to others (or, sometimes, to inanimate objects) cannot be hyperempathy, because the paranoid person does not perceive the hostility so much as he or she creates it.

[A]re individuals with these psychiatric conditions (for that is what paranoia and personality disorders are) revealing the extreme female brain?

This cannot be the case. If someone is over-attributing intentions, or has become preoccupied by their own emotions, then by definition they are not exhibiting hyperempathy. Hyperempathy is the ability to ascertain the mental states of others to an unusually accurate and sensitive degree, and it can only occur if one is appropriately tuned in to the other person's feelings. A paranoid person, or someone who is easily inflamed into aggression by suspecting that others are hostile, has a problem. But their problem is not hyperempathy.

So, if the "female" brain is characterized by special attention to, and a high degree of accuracy in parsing, subtle emotional cues in other people's faces, voices or behavior, a person whose wild imaginings led them to infer motivations that weren't there would be as far off from this mark as someone who simply failed to realize that there was any meaning to be read at all.

Ultimately, Baron-Cohen characterizes the extreme female cognitive type as regular people with a particular gift for connecting with people, but who are also technologically clueless:

A second, and to my mind more likely [than his earlier suggestion of a person who believes in telepathy without being delusional or generally harboring wacky ideas], contender for who might have an extreme female brain would be a wonderfully caring person who can rapidly make you feel perfectly understood. For example, an endlessly patient psychotherapist who is excellent at tuning in to your feelings and situation, who not only says she feels a great sadness at your sadness or great pleasure at your pleasure but also actually experiences these emotions as vividly as if your feelings were hers.

He adds that such a prodigy would have to be "technologically disabled" to a corresponding extent to fit his theory, but supposes that such a disability would not stop her from establishing a meaningful career in the caring professions. He says, to my mind unrealistically, that society values empathizers and provides them rewarding niches while compensating for (or ignoring) their weaknesses in systemizing.

I do not believe that society particularly values its caregivers, though. Most of them (in the US) are unpaid, and depend entirely for their survival on the income and health insurance of their working spouses. When caregiving is also a paid job, it is grossly underpaid and often physically and emotionally exhausting. Even within fields that are fairly prestigious, like medicine, those specialties which are dominated by women tend to be the lowest-paid and least-highly regarded. The specialties women choose are often the more nurturing, caring, do-gooder areas like pediatrics or family practice. Conversely, engineers are compensated quite well, and are unique among the professions for earning power immediately following completion of a bachelor's degree.

(I have one final, random thing to add: I know several hyperempathizers. Of the three I can think of, two are male and one is female. One of them sounds a lot like the idea Baron-Cohen rejected in favor of the wholly-assimilated caring professional: when he perceives other people's mental states, he claims to be seeing "auras." I take this to mean that his brain interprets the subtle signals he's perceiving in a visual way --- much like my own thoughts, experienced by a more superstitious person, might be termed "visions." Ironically enough, this man has an autistic son).