DSM-V to Unify Autism Spectrum, Emphasize Autism "Severity"

Sarah and Sadderbutwisergirl have both posted about this article in last Monday's New York Times, which discusses the American Psychiatric Association's possible abandonment of Asperger syndrome as a separate category in the upcoming DSM-V.

The last time I blogged about autism in the DSM-V, almost a year ago, the Neurodevelopmental Disorders Work Group was still gathering evidence, asking questions and trying to determine its priorities. Among the questions they asked in their November 2008 report were:

1) How to describe the "spectrum" of disorders now known as ASD (e.g., how many domains will define the disorder);
...
5) Whether Asperger's disorder is the same as "high-functioning autism";
...
7) How to include considerations of severity and impairment in diagnosis (currently defined as "qualitative impairments") ...

By the time of their April 2009 report, the work group seems to have found answers to these questions.

The Workgroup is considering a change in DSM-V that would replace the Pervasive Developmental Disorder (PDD) category with the title "Autism Spectrum Disorders" (ASD). The change would utilize a single diagnosis for the disorders currently entitled: Autism, PDD-NOS and Asperger disorder. Several factors support making this change:

• A single spectrum better reflects the pathology and symptoms.
• Separation of ASD from typical development is reliable and valid, while separation of disorders within the spectrum is variable and inconsistent.
• Individuals with autism, PDD-NOS or Asperger disorder often are diagnosed by severity, rather than unique, separate criteria defining the three diagnoses.

The Times article quotes several work-group members on their reasoning behind the proposed merger of autism-spectrum subcategories:

"Nobody has been able to show consistent differences between what clinicians diagnose as Asperger's syndrome and what they diagnose as mild autistic disorder," said Catherine Lord, director of the Autism and Communication Disorders Centers at the University of Michigan, one of 13 members of a group evaluating autism and other neurodevelopmental disorders for the manual.

"Asperger's means a lot of different things to different people," Dr. Lord said. "It's confusing and not terribly useful."

...

Dr. Susan E. Swedo, a senior investigator at the National Institute of Mental Health who heads the diagnostic manual group working on autism, acknowledges the difficulty of describing such a variable disorder. Dr. Swedo said the plan was to define autism by two core elements -- impaired social communication and repetitive behaviors or fixated interests -- and to score each of these elements for severity.

The trick is to "walk the tightrope of truth," Dr. Swedo said, between providing clear, easily used diagnostic guidance to clinicians and capturing the individual variation that is relevant to treatment. "People say that in autism, everybody is a snowflake," she said. "It's the perfect analogy."

The proposed elimination of autism subtypes comes at the very moment when research suggests the disorder may have scores of varieties. Investigators have already identified more than a dozen gene patterns associated with autism, but Dr. Lord, of Michigan, said the genetic markers "don't seem to map at all into what people currently call Asperger's or P.D.D."

Nor have many of these genes been linked to distinct sets of symptoms. Until research can identify reliable biological markers for autism subtypes, Dr. Lord and other experts say, it is better to have no subtypes than the wrong ones.

I do think it's a step in the right direction to collapse all these categories --- autism, Asperger's and PDD-NOS (which was always just a catchall, "Everything Else" category anyway) --- into a single, more flexible one. The criteria for all the different existing categories are really arbitrary, having more to do with one's developmental history (i.e., at what age did you learn to talk?) than with one's current capabilities, and I think the current organization of the PDDs is more a historical artifact than it is logically or empirically based.

However, I have problems with the concept of autism severity they're proposing.

The two domains they propose as being diagnostically relevant, and which will form the basis of a given autistic person's "severity" rating --- social communication and repetitive behavior/fixated interests --- don't seem to have a lot to say about an autistic person's actual strengths and weaknesses. While I can see a communication impairment causing problems in someone's life, and a diagnosis of autism helping that person get the right therapies, services and accommodations they need to minimize those problems, I don't think that unusual social interactions, repetitive behaviors or eccentric choices of hobbies pose many problems for autistic people in themselves. Such "pathological" pursuits can actually be highly successful coping strategies, helping to defuse the intense, chronic stress and anxiety many of us feel. They might also be avenues through which we can develop, or exercise, a talent or skill.

I see no mention in the work group's discussion of what constitutes "severe" autism of any of the sensory, motor, cognitive, emotional or executive-functioning difficulties that can pose serious problems for everyday functioning, self-care and independent-living skill acquisition by autistic people. While communication impairment (on both the sending and receiving ends!) and social agnosia can be severely disabling as well, I still think these criteria are more a list of traits that mark us as Other than they are an accurate gauge of our mental well-being.

That bothers me because, by focusing on such external, superficial characteristics, the new criteria ignore the reasons for our behaviors --- and thus, the question of whether a given behavior is helpful, harmful or neutral --- to consider only the extent to which they differ from "normal" behaviors. Thus, an autistic person who can pass for neurotypical is automatically assumed to be better off than one who can't.

To the extent that simple discrimination accounts for many (but not all) of the problems autistic people face in life, that might well be true. But to the extent that there are sometimes severe impairments associated with autism, that may or may not correlate with one's ability to pass, I think this single-minded focus on appearances does autistic people no favors.

Michelle Dawson critiqued these proposed changes in June, and came to similar conclusions:

The assumption that having more obvious autistic traits and abilities is bad ("more severe") has resulted in prejudicial judgments in the literature. An autistic boy (who has accomplished more as a child and young adult than most people, autistic or otherwise) with a full-scale IQ of more than 100 and a strong performance on numerous tests is judged to be "low-functioning," because he is so obviously atypical. That is, he is judged to be very "severely" autistic (Bonneh et al., 2008; Belmonte et al., 2009), and this must solely be a bad thing. In Aldred et al. (2004), preschool autistic children are falsely judged to be "low-functioning" or "high-functioning" solely on the basis of presumed autism "severity" falsely drawn from ADOS scores. It is being falsely and prejudicially assumed that an autistic whose traits and abilities are more obvious must function poorly.

The proposed DSM-V changes will enhance societal prejudices against autistic traits and abilities. These prejudices already serve to prevent autistics whose traits and abilities are more obvious from being considered able to learn, to communicate, to make decisions about our lives, to walk around freely, to be employed, etc. Under the proposed DSM-V changes, autistics who are highly and obviously atypical would be even more harshly judged, without there being anything approaching a sufficient empirical rationale for this. Autistics whose communication and social interaction is highly atypical, or who most strongly pursue their focused abilities and interests (something which has widely been acknowledged leads to good outcomes, but this has largely not interested researchers; Howlin, 2005), will now be at risk of being regarded as "most severe." This is at a time when the term "severe autism" is popularly equated with low expectations, hopelessness, dread and horror.

Dawson goes on to point out that "severe autism" is commonly invoked to justify abuses committed in the name of therapy. I think this is an excellent point, and well worth considering in a society where autistic people (as well as many other people with developmental disabilities or mental illnesses) are at such risk for abuse.

Halloween

I love Halloween. It's always been my favorite holiday, for lots of reasons. Anymore, my primary mode of celebrating it is to carve outrageous jack-o'-lanterns, the bigger the better.

Here's this year's entry in the "Holy $#?! that's a huge pumpkin" arms race with myself, being interrogated by two of the cats.

You can see they're a bit mystified as to what manner of thing the humans have brought them this time. (The third cat loathes the smell of pumpkin, so she fled the scene).

Boots (the black-and-white one pictured above) was able to discover fairly quickly that this pumpkin was big enough for him to jump into:

Of course, it didn't take him very long after making this discovery for him to lose interest entirely and wander off, as cats will do. But he made this very eloquent expression of disdain before he left:

(It's like he's trying to wave it away with his paw. So cute!)

I Have an Etsy Store!

I just recently got everything together to start selling jewelry on Etsy; I even have a couple of items listed.

My store is called Shards of Elegance.

As of now, you can buy this turquoise bracelet

and this green one

there. Both were made to fit my wrist: the turquoise one is about six and two-thirds inches (approx. 17 cm); the green one is a little looser at seven and one-sixteenth inches (17.8 cm). I have another, slightly shorter green bracelet (6.5 in./16.5 cm) and can make more if you need them bigger or smaller than that. I can't make any more of the turquoise one, although I could resize it.

Psychology Today? More Like Psychology Fifty Years Ago!

(Image created by Anne Taintor)

Pop evolutionary psychology, for all its vaunted iconoclasm, starts sounding awfully familiar when applied to what appears to be its spokespeople's favorite subject, innate gender differences and their implications for how men and women ought to be living their lives.

Here's an example, from another post on Satoshi Kanazawa's Psychology Today blog, this one titled "How to Be Happy":

One of the things that evolution has done is to make men and women very different. In some ways (though not in others), males of one species are often more similar to males of other species than to females of their own species, and vice versa. In some ways, in many ways, men are more similar to male chimpanzees or gorillas than to women. One of the ways that men and women are different is in what makes them happy.

Forget what feminists, hippies and liberals have told you in the last half century. They are all lies based on political ideology and on conviction, not on science. Contrary to what they may have told you, it is very unlikely that money, promotions, the corner office, social status and political power will make women happy. Similarly, it is very unlikely that quitting their jobs, dropping out of the rat race, and becoming stay-at-home dads to spend all their time with their children will make men happy.

(I'm not even going to address the staggering wrongness of the claim that male humans are more like males of other species than they are like female humans. Just take it from me that it is wrong, so extraordinarily, mind-bogglingly bizarre that I can only muster up one word in coherent response to it: No.)

So, men want to go out, make money and rule the world, while women want to stay at home and have babies. Those two nonoverlapping spheres are where men and women respectively excel, and the only place they can truly feel fulfilled.

Where have we heard that before?

It was quite familiar to Naomi Weisstein, who wrote these words (from her essay "Kinder, Kuche, Kirche as Scientific Law: Psychology Constructs the Female") in 1968:

It is an implicit assumption that the area of psychology which concerns itself with personality has the onerous but necessary task of describing the limits of human possibility. Thus when we are about to consider the liberation of women, we naturally look to psychology to tell us what that liberation would mean: what would give women the freedom to fulfill their own intrinsic natures. Psychologists have set about describing the true natures of women with a certainty and a sense of their own infallibility rarely found in the secular world. Bruno Bettelheim, of the University of Chicago, tells us (1965) that "we must start with the realization that, as much as women want to be good scientists or engineers, they want first and foremost to be womanly companions of men and to be mothers." Erik Erikson of Harvard University (1964), upon noting that young women often ask whether they can "have an identity before they know whom they will marry, and for whom they will make a home," explains somewhat elegiacally that "much of a young woman's identity is already defined in her kind of attractiveness and in the selectivity of her search for the man (or men) by whom she wishes to be sought ..." Mature womanly fulfillment, for Erikson, rests on the fact that a woman's "somatic design harbors an 'inner space' destined to bear the offspring of chosen men, and with it, a biological, psychological and ethical commitment to take care of human infancy." Some psychiatrists even see the acceptance of woman's role by women as a solution to societal problems. "Woman is nurturance ..." writes Joseph Rheingold (1964), a psychiatrist at Harvard Medical School, "anatomy decrees the life of a woman. ... [W]hen women grow up without dread of their biological functions and without subversion by feminist doctrine, and therefore enter upon motherhood with a sense of fulfillment and altruistic sentiment, we shall attain the goal of a good life and a secure world in which to live it." (p. 714)

These views from men who are assumed to be experts reflect, in a surprisingly transparent way, the cultural consensus. They not only assert that a woman is defined by her ability to attract men, and thus, a home; for this will allow her to set about her life's task of "joyful altruism and nurturance."

Though the reasoning behind it has shifted with the times, this notion of opposite sexes --- the active, aggressive male and the passive, nurturing female --- has remained more or less constant* in Western culture throughout history.

Equally constant, for as long as there has been a vocal feminist contingent protesting this consignment of women perpetually to kitchen and nursery, has been the experts' response to the feminists. For whatever reason --- whether it was physiological, as in the Victorian belief that brain and uterus competed with one another for a limited blood supply, and thus a woman could not make heavy use of one without causing the other to atrophy; or psychosexual, as in the Freudian belief that a healthy, mature woman's sexuality necessarily revolves around intercourse, and that childbirth represents her ultimate achievement and the only way to resolve lingering issues of "penis envy"; or romantic, as in the more recent backlash idea that a woman must marry young, prioritizing finding a husband and having children above education and work, or else she'll run out her biological clock and find herself unable to marry or have children later on --- deviation from woman's ordained role could only lead to disappointment, bitterness and literal and/or metaphorical sterility.

Indeed, an educated man from any of these eras --- Victorian, mid-twentieth century, 1980s backlash era --- would have been able to write an article very like Kanazawa's, urging women that neglecting their rightful, natural role in life would leave them lonely, bitter and unfulfilled.

If we go back far enough, everything new becomes old again, and we find evolutionary and physiological reasons being proposed for the inherent rightness of women's traditional role.

Psychologist Stephanie Shields describes some of these in a 1975 article in American Psychologist, titled "Functionalism, Darwinism and the Psychology of Women: A Study in Social Myth":

The first systematic treatment of individual differences in intelligence appeared in 1575. Juan Huarte [link] attributed sex differences in intelligence to the different humoral qualities that characterized each sex, a notion that had been popular in Western thought since ancient Greece. ...The humoral theory of sex differences was widely accepted through the 17th century, but with the advent of more sophisticated notions of anatomy and physiology, it was replaced by other, more specific, theories of female mental defect: the lesser size and hypothesized simpleness of the female brain, affectability as a source of inferiority, and complementarity of abilities in male and female. It was the developing evolutionary theory that provided an overall explanation for why these sex differences existed and why they were necessary for the survival of the race.

...

Because variation from the norm was already accepted [in the 1870s] as the mechanism of evolutionary progress (survival and transmission of adaptive variations) and because it seemed that the male was the more variable sex, it was soon universally concluded that the male is the progressive element in the species. Variation for its own sake took on a positive value because greatness, whether of an individual or a society, could not be achieved without variation. Once deviation from the norm became legitimized in evolutionary theory, the hypothesis of greater male variability became a convenient explanation for a number of observed sex differences; among them the greater frequency with which men achieved "eminence." By the 1890s it was popularly believed that greater male variability was a principle that held true, not only for physical traits but for mental abilities as well:

That men should have greater cerebral variability and therefore more originality, while women have greater stability and therefore more "common sense," are facts both consistent with the general theory of sex and verifiable in common experience. (Geddes & Thomson, 1890, p. 271)

...

In the United States the variability hypothesis naturally found expression in the new testing movement, its proponents borrowing heavily from the theory of [Havelock] Ellis and the statistical technique of [Karl] Pearson. The favor that was typically afforded the hypothesis did not stem from intellectual commitment to the scientific validity of the proposal as much as it did from personal commitment to the social desirability of its acceptance. The variability hypothesis was most often thought of in terms of its several corollaries: (a) genius (seldom, and then poorly, defined) is a particularly male trait; (b) men of genius naturally gravitate to positions of power and prestige (i.e., achieve eminence) by virtue of their talent; (c) an equally high ability level should not be expected of females: and (d) the education of women should, therefore, be consonant with their special talents and special place in society as wives and mothers.

Shields has also written more recently (2007) about how nineteenth-century psychologists differentiated the sexes within the realm of emotion:

Female reproductive physiology was at the heart of most explanations of the development of women's distinctive cognitive and emotional character (Vertinsky, 1988). ... The account generally followed this line: The human female's nervous system was limited (or prevented from its full development) either because of earlier achievement of full maturity [than the male] and/or because of the biological demands of development and maturation of the female reproductive system. At maturity, women's brain and nervous system were limited in their capacity to support the higher mental processes, specifically objective rationality and true creativity. The lower mental processes (emotion and certain perceptual skills) thus appeared to be or were comparatively stronger. Then, at menarche, the female's mental future was sealed: Blood that might have promoted further brain development was diverted to the uterus and sustaining fertility. The result of this abbreviated course of development and the demands of female reproductive physiology were limited intellectual capacity in comparison to men and a triad of interlocking traits: sensitivity, perceptual acumen, and, more important, emotionality.

...

In its feminine form, emotion was portrayed as a somewhat unstable sensitivity of feelings toward oneself and others. Masculine emotion, in constrast, was described as a passionate force evident in the drive to achieve, to create, and to dominate. Male/masculine reason was believed to be powered by a distinctively masculine emotion. Although passion could overwhelm reasoned behavior, well-controlled masculine passion is energy focused on "the battle of life." Passion was not simply equated with sexual drive, but as all strong feeling that powered creative thinking, social action, and physical prowess. Manly emotion was distinguished by its capacity to be put in the service of reason (Shields, 2002) and with a broader political definition of heterosexual manhood that emphasized Christian values of autonomy and self-regulation (Alderson, 1998). ... Women's emotion, feminine emotion, was portrayed as lacking the power and energy ascribed to masculine emotion, identified with an inferior and ineffectual emotionality. Women's emotion was more likely to be described as sentimentality, which was itself rendered as a degraded, pale version of normal emotional impulse that, in any event, women were not well equipped to regulate.

Men's emotions are strong, vigorous drives, leading them to do things, while women's, for all their greater refinement, are merely felt. Men are active, restlessly spurred onward, ever onward, by these heroic passions, while women's more diffuse emotionality renders them acutely sensitive to others' needs and emotions without ever feeling anything strongly enough to have emotional needs, or desires, or ambitions, of their own. As Shields points out, this ideal complementarity meshes nicely with the ideal of the nuclear family that was being popularized at the time:

The definition of women's ideal emotion evolved contemporaneously with the identification of women as the center of the household. This domestic image of woman featured emotional temperance and equanimity as its defining themes. Emotionally, the successful household manager was portrayed as expressing calm mother-love and unruffled housewifeliness. ...

The identification of the domestic sphere as one in which woman is the emotion expert (by virtue of natural qualities of attention to detail and emotional influences on judgment) undergirds a domestic structure of benevolent paternalism. As putative "emotion experts," the burden was on women to define healthy emotional home life. Nevertheless, women's tendency for "mere emotionality" calls into question the soundness of their judgment. The legitimacy of women's authority on emotional matters in the home was undermined by beliefs regarding the inherent weakness of feminine emotional nature. The intervention of someone with greater skills in self-regulation would be needed in matters of any importance.

She goes on to describe, and quote, the philosopher, sociologist and early popularizer of Charles Darwin's evolutionary theory Herbert Spencer's (whom we might consider an ancestral Evolutionary Psychologist) ideas about the nature and evolutionary origins of sex differences in human emotion and intelligence. Those ideas, not surprisingly, place male aggression, particularly competition among males, in the driver's seat of evolutionary progress, shaping women's behavior along with men's:

[Spencer, in the 1902 edition of his book The Study of Sociology:] In barbarous times a woman who could from a movement, tone of voice, or expression of face, instantly detect in her savage husband the passion that was rising, would be likely to escape dangers run into by a woman less skilled in interpreting the natural language of feeling. Hence, from the perpetual exercise of this power, and the survival of those having most of it, we may infer its establishment as a feminine faculty.

(This one-sidedness --- female behavior changing in response to male behavior or preferences --- is still entrenched in evolutionary psychology. Evolutionary explanations of female appearance, or, more precisely, female pursuit of feminine appearance, that invoke deep-seated genetic imperatives in the male to choose a young, healthy and fertile mate, abound, in defiance of the usual pattern of sexual selection in which females are the choosy partners).

Given how little was known during his lifetime about human evolutionary history (indeed, we're still very much in the dark about a lot of it), Spencer can be forgiven for making up tales of a Hobbesian state of nature in which the human psyche as he knew it was forged. Today, though, we have more actual evidence to work with than he did, but still the stories that are told about human nature are unchanged.

Sources:

Shields, S. A. (2007) "Passionate Men, Emotional Women: Psychology Constructs Gender Difference in the Late 19th Century." History of Psychology Vol. 10, No.2, pp. 92-110.

Shields, S. A. (1975) "Functionalism, Darwinism and the Psychology of Women: A Study in Social Myth." American Psychologist Vol. 30, Iss. 7, pp. 739-754.

Weisstein, Naomi (1968). "Kinder, Küche, Kirche as Scientific Law: Psychology Constructs the Female." Boston: New England Free Press.

*An interesting exception to this pattern is the cultural back-and-forth over which sex has the more powerful libido. Though it is now believed that men are the insatiable ones, and women the natural prudes, at some other points in history --- the Middle Ages being the first such era that comes to my mind --- this thinking has been reversed, with women being seen as the lustful, animalistic sex and men the higher, more cerebral and spiritual sex.

These Are Not the Eternal Verities of Biology - Part I

I don't read Psychology Today, as a rule --- it strikes me as very much psych-lite, and there are lots of much better neuroscience, psychology and social-science blogs around the Internet --- but Echidne does, and has lately been bemoaning the fact that so few people are criticizing their science reporting, especially on matters of gender differences, where the reigning theoretical framework seems to be a particularly rigid, virulently anti-feminist strain of evolutionary psychology.

The primary exponent of this doctrine on that site is Satoshi Kanazawa, a Reader in Management at the London School of Economics and Polical Science who holds a Ph.D. in sociology from the University of Arizona.

This educational background, you might guess, does not lend Dr. Kanazawa much credibility as an authority on human evolutionary history, genetics, sexual selection, or early hominid reproductive strategies and social behavior.

I'll come back to that in a later post; what I'd like to focus on now is Kanazawa's treatment of a subject that does lend itself to sociological explanation: effects of culture on observed sex differences in wealth, prestige, happiness and mating behavior.

Oddly, when presented with a topic that so clearly invites a sociologist's patient untangling of all its component threads of cultural, historical and economic factors, Kanazawa seems to forget all about sociology.

Instead, in a post titled, incredibly, "Why Modern Feminism Is Illogical, Unnecessary and Evil," he clings stubbornly to "biologically meaningful measures of welfare" --- i.e., longevity and number of descendants --- to argue that, since women live longer than men, and more women than men have at least one child at some time in their lives, women are clearly thriving at men's expense!

The fact that men and women are fundamentally different and want different things makes it difficult to compare their welfare directly, to assess which sex is better off; for example, the fact that women make less money than men cannot by itself be evidence that women are worse off than men, any more than the fact that men own fewer pairs of shoes than women cannot be evidence that men are worse off than women. However, in the only two biologically meaningful measures of welfare -- longevity and reproductive success -- women are and have always been slightly better off than men. In every human society, women live longer than men, and more women attain some measure of reproductive success; many more men end their lives as total reproductive losers, having left no genetic offspring.

As Echidne points out, women's current near-universal advantage in life expectancy is a fairly recent development.

The 1999 Working Paper of the Max Planck Institute for Demographic Research has this to say about how sex differences in life expectancy have shifted around through the centuries:

Today, women have a mortality advantage at almost all ages in developed countries. But this has not always been the case. Paleo-demographers are now establishing evidence that there may have been no life expectancy difference between males and females prior to the development of agriculture. Following the development of agriculture, females may have then suffered higher mortality than males. It has not yet been established whether this female disadvantage was brought about by a heavy work burden, high fertility, the microbiological environment or other factors (Boldster and Paine, 1995). The oldest records on mortality are from England and Wales, and from Sweden. The data reconstructed for England and Wales show that from the early 17th to the 20th century male and female mortality differed only little. In general males had a slight advantage in the 17th and 18th centuries, but females enjoyed lower mortality during some periods.

The authors trace the emergence of a consistent gap between the average male and female life expectancies to the reduction or elimination of two major causes of early death in women: death in childbirth and death from illness or parasitic infestation during youth. While germs don't discriminate by sex, girls were likelier than boys to die of such illnesses as tuberculosis, scarlet fever, smallpox, measles, and the like because girls were more likely to be malnourished, and thus less able to fight off an infection.

Both countries [i.e., France and Denmark] exhibit a female disadvantage [in mortality rates] in early life between the ages of 5 and 15. This disadvantage, which was found in most European populations, was present from 1800 until it disappeared in the 1920s and 1930s. Data on causes of death show that infectious and parasitic diseases account for very high female mortality at these ages, tuberculosis being the main killer. The frailty of young girls from 5 to 15 with regard to tuberculosis has been attributed to hereditary factors, as well as living, working and housing conditions. This excess mortality for girls was the result of the sexual discrimination that characterised Western societies in the 19th century. Various factors played a role here, such as nutrition, housing and hygiene, access to education and medical assistance, and working conditions (Tabutin and Willems 1996).

This article goes into a lot of detail about the tuberculosis epidemic in late-nineteenth-century Ireland, which the article's authors think displayed typically sex-skewed patterns of mortality:

Tuberculosis was a serious problem in Ireland during the surveyed period. The tuberculosis epidemic was rising in the 1880's and 1890's and culminated in 1904. ... The high mortality rates were falling very slowly in the following decades and in the 1940's they were still higher than in many European countries. The reduction of overall mortality rates to European levels coincides with the reduction of tuberculosis mortality.

Mostly youth and young adults were infected by tuberculosis (Jones, 2001). During puberty mostly females died of TB, in older age groups the death rates of TB were more equal between genders. It was more probable for poor people to have TB and urbanisation brought a higher TB rate, men being more affected.
...
The true reasons for the high mortality from tuberculosis and the particular susceptibility of women may have been the same as for excess female mortality [in general]: poverty, urbanisation and malnutrition. In 1871 50% of the female workers in the linen factories of Belfast were aged between 15 and 25 years and hard work and unhealthy environment led to higher mortality rates. Many of them worked at home; the bad housing conditions in urban areas made it easy for the bacillus to spread to women and their daughters who were staying with their mothers while men and their sons worked in the fields. The women who were weakened from the bad living conditions and malnutrition contracted tuberculosis that their body otherwise may have resisted.

Though most, if not all, poor people living in Ireland at that time suffered malnutrition, women and girls got the worst of it, as they continue to do in poorer parts of the world today:

Traditionally, women in Ireland had almost no rights. Girls and women had to have their meals after men and sons had eaten ... . School education was denied to more girls than boys, as women were regarded as not capable [of making] use of the acquired knowledge.

Why am I bringing all this stuff up?

I'm trying to show that, contrary to what Dr. Kanazawa seems to think, sexism really does hurt women in tangible, "biologically meaningful" ways. It kills them, in infancy (girl babies, especially in societies where women have few or no employment prospects and a woman's family is expected to supply a dowry when she marries, are at a greater risk than boy babies are of being murdered by their parents), in childhood (again, when there's not enough food to go around, it's the women and girls who do without, which makes the girls frailer and less able to recover from ordinary childhood illnesses) and during reproductive years (when women don't have the option to terminate a risky pregnancy, or to choose when or if they bear children, they are likelier to die, or be seriously injured, during childbirth).

Furthermore, there's evidence that some of the kinds of cultural changes feminists generally favor --- particularly, changes that would reduce women's economic dependence on men, like making education and employment more accessible to women --- actually enhance infant girls' survival prospects.

Here's an explanation of how that works, taken from V. B. Tulasidhar's 1993 article in Health Transition Review, on "Maternal education, female labour force participation and child mortality: evidence from the Indian census":

Mother's education affects child survival in two main ways: through better child-care practices and higher standards of hygiene at home, and more rational and greater use of preventive and curative medical services (Mosley and Chen 1984; Cleland and van Ginneken 1988). ... It is also argued that education gives greater independence to the mother which will help her [m]ake child-health-promoting decisions without any hindrance (Caldwell 1986). ... Educated mothers are also found to have superior knowledge of diseases and they seek timely treatment more often (see Cleland and van Ginneken 1988). However, some studies deny superior health-care knowledge on the part of educated mothers, particularly among those with lower levels of education (Caldwell, Reddy and Caldwell 1983; Lindenbaum, Chakraborty and Elias 1985). To sum up, the available evidence indicates a strong and independent association between mother's education and child health, but the exact mechanisms through which it operates are not yet clear.

...

The relationship between female labour force participation and child mortality is even more complex. On the one hand, labour force participation can have an adverse impact on child health as the child will not get full attention from its mother and may even forgo the benefits of breastfeeding. This will probably happen in those families where because of poverty the mother must participate in the labour market soon after delivery. On the other hand, the mother's work force participation will enhance the family income which will in turn have a positive impact on child nutrition and health. Thus, the eventual outcome of female labour force participation on child mortality depends on the relative influence of these two routes of causation.

...

Besides female education, three important factors are identified to explain excess female mortality (Bardhan 1988; Basu 1989; Das Gupta 1990). They are, first, cultural preference for male children; secondly, low social status of women; and thirdly, low female labour requirements in areas where rice is not grown. Among these three, the last hypothesis, propounded by Bardhan (1988), is intuitively the most appealing. The underlying factor in the hypothesis is the low economic value of women and hence female children in areas where the labour force participation rates of women are low. It appears that the other two factors (low social status and cultural preference) stem partly from the low economic value of women.

A much more recent (2007) paper by World Bank development economist Shwetlena Sabarwal, written while she was a graduate student in economics at the University of Minnesota, sheds some more light on the relationship between mothers' education levels and daughters' chances of surviving childhood.

Sabarwal tries to account separately for the two things she sees education doing for women, which is informing them and empowering them, and measure the effect of each on child mortality and excess female mortality.

In this analysis, it is proposed that mother's education can affect child health outcomes in three ways: a) autonomy effects of education, b) information effects of education and c) other direct effects of education. Once the autonomy and information effects are isolated from the other direct education effects, some interesting results emerge. First, we see that mother's education influences child health primarily through direct education and information effects and mother's autonomy does not have much predictive power in this relationship. In the excessive female child mortality regression however, women's autonomy has a negative and significant influence. The fact that the female autonomy variable is not significant in the child mortality regression in India runs counter to theoretical literature that emphasizes the education-autonomy link as a major pathway through which maternal schooling influences child mortality. Instead, it is the information effects that stand out as being highly significant, indicating that effective information dissemination is a crucial channel for reducing child mortality.

These results also show that mother's education affects child mortality on the one hand and excessive female child mortality on the other hand in very different ways. Women's autonomy is an important pathway through which mother's education can improve relative survival probabilities of girls. This has important policy implications in that instead of simply relying on female education[,] attempts should be made to enhance female autonomy in a broader sense.

This is a really long, dense post, that in its specifics seems to leap randomly all over time, space, and culture, but throughout it I've been trying to demonstrate, both clearly and thoroughly, that feminism really does help women. My thesis here has been the opposite of Kanazawa's: rather than leave women unhappy, stressed-out and childless, feminism has improved women's health and well-being, and their children's --- especially daughters' --- chances for survival.

Link Roundup, Feminism-and-Disability Edition

To take a bit of a break from all the long, involved thinky and researchy posts I've been doing lately, I'm just going to link to a few things I've seen around the Internet recently and been blown away by.

First, FWD/Forward, an awesome new blog that deserves lots of attention, has been running a series of posts on ableism in language. Each post in the series deals with one word or phrase, like "lame," "vegetable," "retarded," "cretin," or "hysterical."

Also at FWD/Forward, Amanda W. of Three Rivers Fog has enlarged on this older post of AnneC's, "Conceptualizing Autism," to show how it can be applied to all disabilities.

I also discovered FWD/Forward contributor Meloukhia's blog, This Ain't Livin', and really liked these two posts: "Default Settings," about the gender binary, cissexism and compulsory heterosexuality, and "How to Evaluate a Source of Information."

Elesia Ashkenazy of Aspitude! has a very interesting interview on her site, with an anonymous former behavior analyst who voices some problems ze has with ABA:

One day, I was sitting with one of my favorite clients. He was the sweetest nonverbal foodie (he ate everything) who smiled often, and listened well. We had just gone through his set of verbal training programs, and we were having a relaxing break. He was stimming [ex.: finger flicking/rippling, humming, rocking, spinning] on a musical toy and he began hyper hand-flapping. My job was to click each hand flap and *reset* his hands every time. I sat back in realization and wondered to myself: is this treatment truly helping him to become independent? Will he be institutionalized for his entire life? Why does it matter if he hand flaps? Will he find love in his life?

During this rush of emotions, it was like I saw a film reel pass my eyes, and I could see my client sitting in a home twenty years into the future, having never been given an opportunity to grow into his full potential. He had been stunted by diagnosis after diagnosis, prescription after prescription, and treatment after treatment.

How do we expect to *socialize* someone if we never give them a chance to interact socially, and we treat them as if they are rehabilitated animals at a nature center of some sort?

How, indeed. (Though I would argue that animals, too, should be free to engage in whatever odd behaviors they like as long as they aren't hurting anyone!)

Finally, via Shakesville, a wonderful article from Newsweek.com about Dr. Marci Bowers, who does reconstructive surgery, free of charge, for women who've had their genitals mutilated.

"...[Y]ou cannot charge a fee to reverse a crime against humanity," she said. "Sexuality is a right."

Dr. Bowers is transgendered, and she brings up her experiences with transitioning in the video clip, when she's talking about what led her to start doing this work.

EDIT: There's one more awesome thing I read recently, that I forgot to include: IOZ has a thought-provoking response to this New York Times editorial, in which he raises some really important, hardly-ever-asked questions about the nature of the American economy:

... [N]o one seems much interested in the fact that an industrial economy is necessarily pyramidal, that not everyone can be an inventor (or innovator, as goes the preferred neologism) or CEO. You know, even in the Imaginarium of Doctress Rand, it is taken as given that the Atlases of the world must at some point employ and direct the debased lumpenproletariat: there are no illusions that every man is a genius. ...
...
You cannot run a society of three hundred million people by requiring that each either invent the iPod or remain broke forever. Which rather brings up a tangential but dearly held point for the whole gang here at Who Is IOZ? Namely:

You cannot run a society of three hundred million people.

(IOZ is also probably among my favorite prose stylists in the blogosphere, after the inimitable Twisty Faster).

Small Victories

I saw something in this past Sunday's Kansas City Star that gave me a tiny bit of hope, both for our culture in general and the ongoing atrocity that is the Judge Rotenberg Center in particular: the Thayer Learning Center*, a boot-camp-style institution for "troubled teens," which has accumulated a fairly long list of complaints of abuse and neglect of its inmates since its opening in 2002, has closed, and been sold to a Cheyenne Indian educator named Lakota John, who plans to open a new, very different kind of school on the old Thayer grounds.

The new school will be geared toward Native American young people of all tribes, with emphases on sustainable agriculture (using traditional, Native American farming methods), outdoor skills, and Native American culture, art and spirituality.

While I'm sure the original proposals for the old Thayer Learning Center sounded equally high-minded, and while, at this early stage, all we really have are words, I still think that, based on what's been said about how the White Buffalo Academy will be run, there will be factors in place offering some protection against a Thayer-like pattern of systematic abuses taking root there once more.

First, and to my mind foremost, where Thayer kept its inmates isolated from their families and from the larger community of Kidder, Missouri, the White Buffalo Academy is meant to be extensively integrated with various communities: not just Kidder, but also with the various Native American tribes, international humanitarian organizations, and, eventually, other schools and youth organizations (like the Boy and Girl Scouts) across the region.

From the Chillicothe, Missouri Constitution-Tribune:

"If he does what he plans to do, I think it will be a huge asset to the community," says Kidder Mayor Melissa Gough of Lakota John. Her concerns about the future of the facility center on the controversies surrounding the former teen boot camp. ...
...
Mayor Gough has expressed her concerns about secrecy surrounding the former operation to Lakota John and he has assured her that students who may help with trash pickup and other community projects in Kidder will be allowed to talk to locals and give their names (Thayer cadets were not allowed to do so). In fact, he wants to be open and totally honest with the community and invites anyone who wishes to come and visit the facility and talk to him about his plans to open the academy in the next 30 days.

From the St. Joseph, Missouri News-Press & Gazette:

The school will become part of the Utah-based Sacred Path Recovery Program [link], with plans to open in all 50 states and Canada. The organization is composed of various tribes. An informational brochure said Sacred Path "is designed to help people identify, process, and release the issues that deny them the right to live happy, productive lives."

Traditional American Indian methods will be utilized.

"It's for all kids that want to achieve a higher level of learning," added Lakota, whose ancestors hailed from the North American plains.

The academy also will feature American Indian powwows, drumming, sculpting, equestrian arts, an amphitheater with surround sound for various performances, and other activities. Vietnam War veterans will be brought in as speakers.

Another emphasis will be placed on growing quality food, proper eating and overall wellness.

"We're going to start an agricultural program," he said. A slow-drying process for food will be created to benefit overseas humanitarian projects, and negotiations are under way with major companies for their assistance. Herbs will be grown on a farm and livestock will be raised. Outdoor skills will be taught.

"Our soils are going to be phenomenal," he said.

Plans also call for extending invitations to the region's scout programs and schools. The academy will serve perhaps 100 students.

"My thing is making sure we do things in moderation," Lakota said. "We want to build a community of solid individuals ... I want to do this very low-key. We want to do this with love."

The academy will offer preparatory education for students who wish to enroll at Haskell Indian Nations University in Lawrence, Kan., and other institutions. A grand opening date for the White Buffalo Academy will be announced later.

Besides the emphases on transparency and community involvement, which at the very least would make abuses harder to keep hidden for very long, as the Thayer owner-operators did, I also think I see an important difference in the two enterprises' attitudes toward the young people in their care. Thayer Learning Center's guiding principle was literally to break the wills of its young inmates: the harsh treatment and withholding of basic necessities (like, say, water, food, rest, opportunity to bathe) until inmates "earned" them by obedience were meant to teach these willful children "the meaning of no." A philosophy like this is practically a recipe for abuse and neglect, because when you treat people who depend on you like enemies to be vanquished, you will react to everything they say or do as if it's a threat or a stratagem. You'll learn to ignore their signs of distress, and you'll let them die --- of something as treatable or preventable as a spider bite or overexertion or dehydration --- before you'll risk letting them put one over on you.

I don't see this kind of alienation in any of the online material I've seen about White Buffalo Academy or its parent organization, the Sacred Path Program. Rather than stamp out behaviors/attitudes they don't like, these organizations seem more interested in empowering their students, teaching them to be the best they can be and restoring their ancestral heritage and culture to them.

So, on to the million-dollar question: What factors forced Thayer Learning Center to close, and can similar factors be made to converge on the Judge Rotenberg Center? What makes these two abusive institutions different?

*Pedantic linguistic aside: I *HATE* the euphemistic use of "learning center" to describe what is essentially a prison. While the mental and behavioral adaptations people make to survive in a prison/institution environment --- keep your head down, don't cause trouble, don't draw attention to yourself, keep quiet, mind your own business and do as you're told --- might be called "learning," in the Skinnerian sense of that word, they also tend to sabotage a person's capacity for any other kind of learning. You get really good at surviving that hostile environment, but the price you pay is that you lose those parts of yourself that don't help you do that.

Laura Tisoncik describes this kind of psychic shriveling really well in this 2004 conversation with Amanda Baggs:

I spotted [characteristic psychiatric-institution-survivor behavior] in you right away. How do I describe it? You were an obvious case of it. You had a kind of submissiveness ... you were oftentimes looking for where the rules were so you could follow the rules. ... You were waiting or looking for the institution around you, as if, it's like, "Where is it, it's hiding here somewhere!" This is not necessarily a very constructive behavior out in the real world, because it is particularly passive in many ways, and because it is sort of like looking around for it. I really got a sense that you were looking around all the time for the rules. And terribly terrified that you were violating all the rules.

How *NOT* to Do Superhero Halloween Costumes

CaitieCat at Shakesville linked this somewhat hilaristurbing Comics Alliance article about Disguise Costumes' new line* of Marvel-superhero-themed women's Halloween costumes.

What could be more awesome than having a wider selection of ready-to-wear Marvel superhero costumes? Well, like Comics Alliance's Nick Nadel writes, it'd be a lot more awesome if these costumes actually looked much like the characters they're supposed to portray.

For example, there are three characters in the Marvel universe who might be considered female equivalents of Spider-Man: first, there's Spider-Woman**, who looks like this:

There's also Spider-Girl, who was introduced in a "What If?" one-shot comic, as the superpowered daughter of Spider-Man and his true love Mary Jane Watson. She dresses more or less exactly like her father does, in the blue-and-red spider suit:
Finally, there's Araña (Spanish for "spider"). She's a teenage girl with spider powers, and she dresses in street clothes with a spider motif:
None of these amazing characters look even a little bit like this, however.

This is more or less the pattern for all the characters featured in this line: make a standard-issue Sexy (Whatever) costume, with short skirt, bustier/crop top, and tall, vertiginously high-heeled boots, and add little details to evoke the character. Thus, Spider-Girl here looks more or less like the Black Cat looks more or less like Emma Frost looks more or less like American Dream. Only in Emma Frost's case is the resulting costume anywhere near resembling something the character in question would actually wear: hers is, if anything, a bit more modest than the outfit she wore for all those years as the White Queen of the Hellfire Club!

But the most WTF-inducing part of that article, for me at least, was this.

Sexy Venom?! That really, really does not compute.

It does not compute, because Venom looks like this:

You try to make that cute and attractive, and I'd argue you lost sight of the essence of the character a long time ago.

(In answer to your no-doubt-unasked question, "What's even more hilaristurbing than a Sexy Venom costume?", I give you a commenter at Comics Alliance's assertion that the blonde young woman modeling the Sexy Venom costume is none other than Carrie Prejean, Miss Anti-Gay California herself. How weird is that?)

*I was only able to find one of the costumes --- this one, the Sexy Cheerleader version of Captain America with the shield maybe a third the size of the one the model is holding --- on Marvel's own website, so it looks like the Women of Marvel line is mostly Disguise Costumes' brainchild. The Comics Alliance article gives the impression that Marvel is involved, but Disguise's website just says the costumes are "inspired" by Marvel superheroines, and you'd think that if Marvel had any role in designing the costumes, that they'd also be selling them on their site, which they're not.

**There have been multiple Spider-Women over the course of Marvel canon, but I am referring to Jessica Drew, the first, current and --- I believe --- longest-running holder of the title.

But What About the (Aspie) Men??!

There's a phenomenon I've been noticing off and on for a long time in online discussions of rape culture (most recently, here), and the snap decisions women have to make all the time about how much to trust each random man* they encounter: when women start talking about what sorts of cues and impressions tell them to avoid a particular man, other people pipe up to tell them they're being unfair.

Most often, the appeal takes this form: What if he's just got Asperger's? Those Asperger people, they can't tell what kind of signals they're sending, or that they might be creeping you out! Give creepy-looking dudes a chance!

This derailing tactic also commonly appears in discussions of consent, where it usually plays out like this: Feminist blogger writes about the myriad social pressures on women to say yes (or at least not say no) to sex they don't want; feminist blogger suggests that our understanding of what rape and consent are should reflect this, and proposes a model of consent resembling this one, or this one, or this one; whatever model the feminist blogger espouses, it's going to put more responsibility on men to make sure their female partners really want to do X sexual activity; male commenters pop up complaining that women's body language is just too danged hard to read, and if the feminist blogger's plan were adopted, hardly anybody would ever have heterosexual sex ever again!

The man with Asperger's usually makes his entrance here, as an extreme example of Everyman's dilemma.

Of course, this is all perfectly true --- autistic people do often fail to understand nonverbal cues, social context, or how other people are likely to interpret their actions, which does mean that straight autistic men will probably creep out a lot of strange women as they try to teach themselves to flirt (or not; I don't know how to flirt and have no desire ever to learn) --- and sometimes this fact can be brought up and discussed in a non-derailing manner**.

Far more often, though, it's brought up not to add anything to the discussion at all, but to end it. Straight men's oft-proclaimed incapacity to decipher the subtle ambiguities of straight women's facial expressions and body language places all the onus for creating a safer, more egalitarian heterosexuality back onto women's shoulders.

An example, from this comment thread at Hugo Schwyzer's blog, is this response to this earlier comment:

You [referring to previous commenter] have already said that some of the men in your experience can't read the non-verbal clues. That wasn't me. That was you.
So that's the way it is.
In other words, that's the world now.
It makes no difference if men are hardwired or if men are clueless. Your experience has told us that some aren't picking up your nonverbal clues. So what are you going to do about it in the immediate future?

Wishing won't make it change.

That's the way it is, and wishing won't make it change. So either do something about it (all by yourself, naturally, since we men are clearly unwilling or unable to help you) or shut up and quit bothering us!

"saying many men currently DO NOT correctly interpret nonverbal signals (or notice them at all) is not the same thing as saying that men CAN'T. do you seriously not get the difference between those two statements?"

I think this is unfortunately both true to some extent: a) men (on average) don't learn to be as good as they can be in interpreting non-verbal communication. This is something that can be dealt with if there was a real recognition that they needed help in this area, that not everything is "naturally" given or not, and b) men (people with a male brain structure) will on average ceteris paribus never be as good as women (people with a female brain structure) are on average when it comes to interpreting non-verbal communication. There are researchers who suspect that "autism is an extreme version of the male condition." (Simon Baron-Cohen)

"Many of these sex differences [in empathizing and systematizing] are seen in adults, which might lead to the conclusion that all they reflect are differences in socialization and experience. But some differences are also seen extremely early in development, which may suggest that biology also plays a role. For example, girls tend to talk earlier than boys, and in the second year of life their vocabularies grow at a faster rate. One-year-old girls also make more eye contact than boys of their age.

In my work I have summarized these differences by saying that males on average have a stronger drive to systemize, and females to empathize. Systemizing involves identifying the laws that govern how a system works. Once you know the
laws, you can control the system or predict its behavior. Empathizing, on the other hand, involves recognizing what another person may be feeling or thinking, and responding to those emotions with an appropriate emotion of one's own.

...

We know that culture plays a role in the divergence of the sexes, but so does biology. For example, on the first day of life, male and female newborns pay attention to different things. On average, at 24 hours old, more male infants will look at a mechanical mobile suspended above them, while more female infants will look at a human face."
[link]

There are several rhetorical sleights of hand at work in the invoke-the-Aspie gambit. First, there's the handy conflation of autistic men (who, if we use the current thinking that about 1% of people are autistic, and that the ratio of autistic men to women is 4:1, should represent about 0.8% of people, or 1.6% of men --- a tiny minority, even if not as tiny as it used to be reckoned) with all men. In the first comment I quote, the argument is that because some men really can't read nonverbal signals, no man should be expected to***.

This line of argumentation also completely erases autistic women from the discussion, by making "autism" synonymous with "clueless, socially awkward man who can't understand his mysterious female partner." Autistic women might have that kind of problem (or we might not, since I think we might be likelier than autistic men to be partnered with other autistics****, with whom there isn't quite so much of a body-language barrier), or our difficulties with nonverbal cues, social context and other stuff falling under the umbrella of "intuition" or "common sense" might take a more sinister form. Earlier in this post, I mentioned the snap decisions most women make every day to try to minimize their chances of being raped by a stranger. Such snap decisions are often going to rest on evidence of the type that's completely invisible to many autistic women.

This tactic is also a way to use intersectionality against feminists: a feminist who confesses hirself unsympathetic to the hypothetical Aspie bachelor's plight opens hirself up to accusations of ableism. (Or, in the weaker version of this appeal, where the hypothetical man is not an actual autistic but just a well-meaning, socially awkward, geeky guy, the feminist becomes the stuck-up Mean Girl who won't give the sweet but wallflowerish Nice Guy the time of day. Since most women have been socialized to be nice, and polite, and not selfish or superficial, this high-schoolish taunt can have surprising power even over grown women).

*The Shapely Prose guest post I linked to uses a wonderful phrase to describe this: "Schrodinger's Rapist." Every man hovers in a sort of quantum superposition between Rapist and Not-Rapist in the eyes of the women who have to interact with him, and often women will err on the side of caution --- assume every man you meet is a rapist --- because the alternative --- trusting a man who later rapes you --- is horrible. More horrible than having to live as if half the people you run into on a daily basis are violent criminals who will hurt you if they're given the chance.

**I think the commenter at Shapely Prose who first brought up autism accomplished this. She might've been the first person I've ever seen raise that issue in good faith, though.

***I do hate that the discussion of consent always goes there, just because there are people who can't read those signals, and such people do sometimes have sex. Where I part ways with the "What about the Aspie men?!" crowd is that I insist that, if a man can't get a reasonably clear idea of whether his partner is enjoying herself just by looking at her, he should stop and ask her. Is that really so hard?

****If you're wondering how that can possibly be true, remember there are a lot more diagnosed male autistics than female ones.