Snapshots of Disillusionment

There's a book I have, From Poor Law to Welfare State, that's a history of welfare programs in the US, from the colonial period to the mid-'90s or thereabouts. It's a hugely informative book, and maybe one day I'll write a more substantial post about it.

But today I just want to point out something interesting --- if also very depressing --- about the particular edition I own.

It's the Sixth Edition, and after the author's preface it has all the prefaces from every earlier edition. So you can almost travel back in time, reading how the author's thinking and outlook evolved as he had to keep updating the book. (There's a span of, like, more than twenty years between the publication dates of the first and sixth editions, and they happen to be twenty very momentous years in the history of welfare policy.)

What's depressing, though, is that in every successive preface he has to point out that he had been overly optimistic in his concluding remarks to the previous book. 

Here's a snippet from the preface to the Second Edition (1978):

The initial version [of this book], completed early in 1973, brought the account of social welfare in America up to the start of this decade.To leave it at that critical juncture would be to shirk an obligation to readers who have witnessed the important, often complex occurrences since then and who seek to know how they are related to prior events. One of the most significant elements in the new edition, then, is the addition of a chapter on the 1970s, “Where Do We Go From Here?” 

I was especially pleased to have the opportunity to bring the text up to date because, writing some five or six years ago, I ended the manuscript on a rather optimistic note. For reasons discussed in the work, I suggested that “as 1970 approached, all was not bleak”; despite the lack of progress, “there were rays of hope.” Events over the past half-decade have proved me unduly sanguine, as the new concluding chapter indicates. Perhaps a future edition of this work will see the restoration of my confidence in the future; I hope so.

 And here's one from the Third Edition (1983):

Less than two decades ago, during the “booming” 1960s, a consensus existed in America regarding the welfare state. Few people on either side of the political aisle opposed strengthening the Social Security system or even declaring “war on poverty.” It was widely believed that the federal government was responsible for the well-being of all citizens, including their basic economic security and their physical and mental health. 

Now, in the midst of a long period of low productivity, deep recession, near-record levels of unemployment, high inflation, and widespread and growing suffering, the welfare state is under severe attack. In the forefront of that attack is the Reagan administration, with its neo-conservative philosophy. After his landslide victory in 1980, Ronald Reagan and his business-oriented advisors came into office intent on altering the direction of public affairs, particularly with regard to the scope and costs of federal activities and the relationship between the public and the private sector, especially in the area of social welfare. Since that time, they have consistently sought, with great success, to eliminate some federal and federally subsidized welfare programs and to cut back on others in a concerted attempt to reverse the steady drift toward Washington’s greater involvement in the nation’s social welfare system. 

The assault against the welfare state has come from the left as well as from the right, from radical scholars and activists as well as from conservative politicians, businessmen, and working class Americans. During the past fifteen years or so, the literature on social welfare, in fact, has been dominated by critics from the left, those who advocate the so-called social control thesis — the argument that the middle and upper classes have devised and used the nation’s welfare institutions and agencies not to help but to control the needy in order to safeguard the existing class system, perpetuate capitalism, and serve their own interests. In fact, so pervasive had such a view become that David Rothman, one of the authors of a widely cited statement on the “limits of benevolence,” rightly indicated that there even existed a widespread and acute suspicion of the very idea of doing good: “Whereas once historians and policy analysts were prone to label some movements reform, thereby assuming their humanitarian aspects,” Rothman wrote in 1978, “they are presently far more comfortable with a designation of social control, thereby assuming their coercive quality …” 

Activists of all kinds also see the needy as less beneficiaries of a benevolent society and more as victims of an all-controlling state; such activists include radicals who preach “participatory democracy” and “community control,” liberals fed up with big government and the federal bureaucracy, and even some social workers and members of the other helping professions who are convinced that the “experts” or “helpers” do not really help, that their professional knowledge, techniques, and institutions have been used to promote a sort of societal imperialism designed to keep the needy in a dependent position in order to perpetuate and enhance professionals’ own role in society. 

This, then, is an exciting and challenging (if not very encouraging) time to be thinking and writing about American social welfare history and the social work profession — and one of the justifications for a new edition of this work.This revised text is a product, at least in part, of the many things that have happened in the field, intellectually and practically, since the appearance of the last edition in 1979.

... the Fourth Edition (1988):

At the conclusion of the Preface to the third edition of this book, written in July, 1983, I stated, “Perhaps … a later edition of … [this] work, should one appear, will have a happier ending.” Unfortunately, that is not so. Despite the efforts of the outgoing administration to deny and conceal the fact, millions of American citizens remain mired in poverty. Indeed, the situation has worsened over the last eight years. In point of fact, there are now more Americans — especially women and children — who are poverty-stricken and in many cases homeless and hungry than there were when President Reagan took office. In addition, in cities all across the nation, there has developed a demoralized “underclass,” comprising school dropouts, gang members, hustlers, criminals, drug addicts, drifters, and other marginal and functionless people who often prey upon and terrorize innocent citizens and threaten the very fabric of American life.  

This new edition gave me the opportunity to take account of, and analyze, these developments and to put them into historical perspective. In so doing, I came to realize that “Reaganism” was not merely the continuation of policies initiated during the Nixon, Ford, and even Carter administrations, as I had believed (and written) earlier. In retrospect, it becomes clear that the period from 1969 to 1981 was a transitional era between the Kennedy-Johnson administrations, with their idealistic and grandiose social policies, and the Reagan administration, with its far more punitive and restrictive measures — measures that, for the first time, were designed to undermine and undo the welfare state that had emerged in America during the prior half-century. 

... Fifth Edition (1993):

Ordinarily, authors are quite pleased to have the opportunity to revise and update books they had written previously. Certainly that was the case with me, as for example my comments in the Preface to the Second Edition indicate. Unfortunately, however, that was not so this time. For the most part, revising and updating this work proved to be a difficult and depressing task.  

The last edition of this book, published in 1989, concluded with George Bush’s election to the presidency after eight years, under Ronald Reagan, of unremitting horror for the nation’s poor. Since that time, however, as I feared, conditions only have gotten worse. Under Bush, the war on the welfare state continued, poverty intensified, and homelessness and a variety of other related social problems reached new heights. All the while, the occupant of the White House and his supporters, who viewed the needy with indifference, if not scorn, did nothing — or worse: they cut even more holes in the social welfare safety net, such as it was. And while the violence that erupted in Los Angeles in the spring of 1992 thrust the state of America’s inner cities and urban poverty into the public consciousness once again, and even rekindled some public debate on these matters, certainly it did not propel them onto the public agenda, at least not yet.  

If there is any light at the end of the tunnel, it is the fact that the twelve dark and dismal years of the Reagan-Bush era have come to an end, and — as I indicate in the conclusion to this work — there is hope (although not quite as much now as there was immediately after the 1992 presidential election) for the onset of a new domestic order, one that will allow Americans to regain their “dignity as a just and compassionate people,” as the authors of The Greatest of Evils: Urban Poverty and the American Underclass (1993) put it. 

... and Sixth Edition (1999):

The first question most readers undoubtedly will ask is, why publish a new edition of From Poor Law to Welfare State this time? While there are a number of reasons for doing so, there are two compelling, although related, answers to that question. First, the previous edition of this work ended on a rather upbeat, or optimistic, note. President Bill Clinton had just introduced his sweeping proposal to overhaul the nation’s health care system, and while many questions about that undertaking remain unanswered, I wrote that “most Americans reacted favorably to the plan and looked forward to the upcoming debate over its specifics.” Furthermore, to again quote from the last edition, “there seemed to be bi-partisan support, in and out of Congress, for the notion that the time had come for some sort of universal national health insurance scheme.” Obviously, I was wrong, and I am glad to have the opportunity to correct myself — and to explain why I was mistaken.  

Second, and closely related, I also misunderstood, or placed too much faith in, President Clinton and his commitment to helping the needy by getting to the heart of their problems — and using the federal government to help resolve them. I really believed, I am somewhat embarrassed to admit, that Clinton, “unlike his immediate predecessors, who either did not recognize the nation’s social problems or refused to face up to them … certainly admits that the nation has many such problems, … that it cannot afford to ignore them, … and that the public sector can and should help to resolve them. Just as our colonial ancestors viewed their villages and towns as communities [I wrote] he cries out for the government again to become an instrument for the improvement of its citizens’ lives, especially by providing at least a minimal level of social welfare for all of its inhabitants.” 

Again, I proved to be in error. Indeed, as readers may already know, or will discover from reading the “new” last chapter of this book — the title of which I changed from “Toward a New Domestic Order?” to “Looking Forward — or Backward?” — just the opposite occurred. Thanks to what is referred to as the welfare reform act of 1996, signed into law by Clinton (just prior to the upcoming presidential election) over the protests of a number of concerned citizens, the entitlement to welfare, put into place in America some sixty years ago in the midst of the Great Depression (if not earlier, during the colonial period), has been removed and replaced by the “work or starve” mentality of an earlier time. 

More About Stigma

Miri at Brute Reason has a very thought-provoking post up about social stigma, and whether anyone deserves to be stigmatized.

She doesn't think so, and she gives lots of very good reasons, including these:

When a group is stigmatized, they are considered less than human in some ways. Whichever aspect of them is stigmatized becomes the whole of their identity in our eyes,  and often this means that even if they change the actions that caused them to fall into that category in the first place, the stigma remains. ...
...
[W]ielding psychological manipulation as punishment really, really rubs me the wrong way. The attitude that if someone does something bad they deserve to be cast out and hated and seen as inhuman scares me. I think it's very normal and understandable to want to punish someone for doing a horrible thing, but, as I wrote after the Steubenville verdict, I'm not sure that's the most useful and skeptical response. I feel that our primary concern should be preventing people from doing bad things (both first-time and repeat offenses) and not satisfying our own need for revenge by punishing them.

But, as good as these arguments are (and I am still turning them over in my head, and will probably keep this idea, that stigma and ostracism are inhumane and that there is nothing anyone can do that is bad enough to make them deserving of such treatment, for a very long time*), I'm not sure I can follow them all the way.

Between the ongoing story I've been following in my local newspaper about a girl in my city --- identified only by the initials LP --- who was found locked in a closet in her mother's apartment and my discovery of the Homeschoolers Anonymous blog, and also Libby Anne at Love, Joy, Feminism blogging somewhat regularly about the disturbingly popular child-rearing philosophy of Michael and Debi Pearl, my mind has been more preoccupied than usual with the vilest, most extreme forms of child abuse.

I commented on Miri's blog that, if anyone does deserve to have a stigma permanently attached to them, it's the perpetrators of those horrors, particularly the Pearls (who were not content merely to abuse their own children, if indeed they followed their own method, but who wrote books proclaiming their combination of hard-core obedience training, enforced by frequent beatings, and withholding food from "defiant" children is the only thing that will guarantee a child will grow up to be a Godly person who is saved from Hell) and the mother in this ten-part personal narrative on Homeschoolers Anonymous.

Doing that to a child, for as long as the anonymous author's mother did --- from the spread in ages of the various children in the family, and the author's Conclusion where she mentions that her two youngest brothers are still with her parents and the abuse is ongoing, it had to have been more than a decade --- is a world away from, say, committing an armed robbery. This wasn't a single act, this was a long-term campaign this woman waged against her children. She stayed at home, ostensibly "homeschooling" her children throughout this period, so it's hard to see a line between these acts and the rest of her life. 

Yet, with the LP story, which is just as horrific, and which makes me feel just as much rage on the victim's behalf, I can see more of Miri's point. LP's mother was very young when she had LP, and at several points in the story you can see hints of someone who was overwhelmed, and who might never have done what she did to her daughter if she had gotten the help she needed but probably never asked for. It's hard to see whom it would help to stigmatize her, when she was already probably stigmatized for other reasons (poverty, blackness, living in a subsidized apartment, being an unmarried mother of three children by two different fathers), which might well have contributed to her feeling that the only thing she could do with her eldest daughter was to keep her out of sight.

But the Pearls, and the parents in the anonymous woman's story? They're not stigmatized at all, except by people like me, who have no power in their lives or social contact with them, or people who have left the conservative evangelical Christian circles those people move in. Within that community, they are revered as leaders and role models. I'm sure that this knowledge is part of the reason I want so badly to rain down opprobrium upon them: because, unlike Jacole Prince, they're getting off scot-free, and they continue to believe that what they are doing is right.

And Miri does grapple with the problem of great evil in her post, too --- where I chose to focus on child abuse, she wrote about rape. And she made another great point in doing so:

Being a convicted rapist is actually a very stigmatized identity -- it's just that rapists rarely become convicted rapists. Rape is known to be a Very Bad Thing, but rapists know that they can get away with it if they commit it in certain ways. Despite the stigma, rape is pervasive and rape culture exists.

I absolutely see a dynamic like this playing out in mainstream society's attitudes about child abuse; child abuse is so heinous, so evil, so stigmatized that we can't ever believe anyone we know is abusing their child. So we second-guess ourselves when we start to wonder about a child's suspicious bruises, unexplained absences, dirty clothes, poor hygiene etc. The stigma attached to child abuse is terrible, so we are reluctant to call it down on our neighbors' heads, even if we suspect they are abusing their children. What if we're wrong? We'll have ruined an innocent person's life! 

(This will sound painfully familiar to anyone who has been raped, or who has spent any time reading about rape culture.)

Another thing worth pondering about this problem as it pertains to child abuse is that, when the child who is being abused, neglected, or even murdered has a disability, the abusive, neglectful or murderous parent is not stigmatized so much as they are pitied. The poor dear, she was carrying an impossible burden. 

A mother can appear in a film in which she tells the camera she has thought about putting her autistic daughter in the car and driving off a bridge with her, and the main reaction to this film will be sympathy, not shock or horror. 

I point this out not to argue that parents of disabled children don't deserve sympathy, or much better support than they're currently getting from society at large, but to argue that this reaction leaves no room for the child. They're a person too, and they have the right to food, shelter, medical care, education, love, and as much freedom and autonomy as is developmentally appropriate**. Focusing on how hard it is to care for a disabled child, even if you're only trying to explain the parent's actions, works to excuse the parent and put some of the blame for their fate onto the child. It also works to make life harder for all disabled people, because it makes it sound like we're being unreasonable just by existing, and that attitude is exactly the kind of attitude that resists making accommodations for us, even when those accommodations are not particularly expensive, awkward or difficult.

Particularly when we're talking about children whose disabilities are behavioral, this idea that it's just too hard works to excuse awful things like restraint and seclusion, at home and in school. At its extreme, it can lead to parents keeping their disabled children in dog cages; they see no other way to treat them because it's too hard and it's not like the children are normal children, for whom such treatment would be abusive, no, they're abnormal children for whom it is necessary.

So even while I see that a heavy stigma attached to child abuse can be counterproductive, in that it might discourage people from reporting their suspicions, I also think there are some kinds of abuse that are not heavily stigmatized, that are even excused (i.e., abuse of children with disabilities, which is often framed as a tragic consequence of disability) or met with approval (i.e., abuse within insular communities that don't share the wider culture's norms).

And it makes me furious that there isn't a heavy stigma, that people like, say, Michael and Debi Pearl don't even think they've done anything wrong, and sleep the untroubled sleep of the just.

*"Keeping an idea" is what I do when I read or hear something that blows my mind, but that I do not immediately know whether to accept it as truth. I kept a lot of ideas related to feminism in the (long) time before I decided I was a feminist, and I kept an idea of Richard Dawkins's that I now think I do believe is true, that raising a child to believe in Hell (at least, a Hell that they could go to --- I'm not sure it's true if Hell is only for big evildoers like Hitler and Stalin) is an abusive practice. I'm also keeping the idea that veganism is a moral imperative for those who are able to adopt it. A lot of the ideas that I keep are of the form "actually, this thing that we do all the time is bad, and you should stop doing it/get other people to stop doing it.")

**This notion --- that freedom and autonomy can't be absolute when you're talking about children --- is actually more complicated than it sounds, especially when we're talking about children with disabilities, or dependent adults with disabilities. How can you define what is "developmentally appropriate" for a child whose development has been atypical? Especially if said child is ahead of his age in some ways while also being delayed in others? (This was me, and I suspect it is most autistic people!) I know only this much: the way these decisions are currently made gives too little freedom to developmentally disabled adults.

Two Quick Links about Why the Fight over Evolution Matters

So, apparently Kevin Drum, a political commentator I don't read but who is apparently somewhat well-known, has written an article for Mother Jones declaring the fight over how whether biology is taught in public schools an irrelevant sideshow. 


I was nonplussed by this. Obviously, it's not the most important issue in the world --- it doesn't pose an existential threat the way climate change, peak oil/peak everything, overpopulation and hunger do, and it doesn't have the dire social consequences (or moral urgency) of, say, restricting access to contraception, the mass incarceration of people of color and poor people, increasing economic inequality or the deliberate demolition of the welfare state --- but I still felt like it had some importance that went beyond mere cultural border-policing*.


Amanda Marcotte at Pandagon and PZ Myers at Pharyngula both responded to Drum's article, and each of them made points that rang true for me, and helped explain why his statement bothered me.


Amanda:

I have to admit, I'm boggled at Kevin Drum's reaction to the news that nearly half of Americans are young Earth creationists ... . He completely misreads the situation and frankly does so in a way that I personally felt thrown under the bus.

... 

Kevin takes it as a given that fights over what's taught in high school are strictly about symbolism and have no real importance. I suspect that's a much easier view to take if you're the beneficiary of a good public school in a blue area or lucky enough to have gone through or been able to put your own kids through private school. For someone who went to a rural high school in Texas, the notion that high school doesn't matter strikes me as ridiculous in the extreme. 

The reason conservatives target high schools (and junior high schools and elementary schools) isn't because they're playing for peanuts. On the contrary, conservatives understand something liberals don't, which is that if you get people while they're young, you usually have them for life. This is also, incidentally, why conservatives pay more attention to pop culture than liberals. Liberals are great people --- I'm one of them! --- but  we have a tendency towards preening individualism and therefore discount the importance of things like what's in the classroom and what's on TV because we personally feel we're iconoclasts who aren't affected by it. Which can, in this case, cause us to neglect to remember that in fact this is the air that most people breathe, and the quality of that air matters. 

I also had strong feelings of no you're wrong when I read the paragraph in Drum's article where he dismisses "a 10th grade understanding of evolution" as something so piddling as to be dispensed with entirely, so much does it pale in comparison to the understanding of evolution one gets (presumably) in college, or in books on evolutionary biology. PZ, along with a slew of other biology professors in his comments and at Mother Jones, takes him to task for this; they write that, no, actually, they have noticed a change in how readily their students grasp what they have to teach. Almost as if high school curricula were geared toward preparing the students for college ... 


Anyway, what felt unfair to me was his assumption that, if people needed the knowledge, they could always pick it up elsewhere. This made me angry, because for many people there is no "elsewhere," or at least not one that is immediately accessible without guidance. 


(Who has tried to teach themselves a completely novel subject by checking out books on it from the library? Isn't it hard to figure out which books will be the ones you need? Technical books are often overly specific and assume you've already got a grounding in the subject, and are interested in exploring a particular question within it, and books for laypeople might not be thorough enough, and also might not be trustworthy). 


As for college, well, not everyone goes there, most of the people who go there will never encounter evolution in the classroom --- I didn't, and I majored in a biological science! --- and, again, college professors have enough to do without having to burn up lecture time with remedial material and correcting misinformation. Plus, not all colleges are created equal; some 


To top it off, what you know before college helps determine where you go, whether you go at all, and what you study! College is expensive, and for many prospective students (I know I felt this way when I was applying to colleges) the size of the scholarship you can get makes the decision for you. Scholarships for merit, as opposed to need (and there will always be more people who can't really afford college than there are people officially deemed too poor to afford college on their own), depend on how one performs on standardized tests. And what does standardized test performance depend on? What you learned in high school.


There's more: as Amanda also points out, what you're exposed to in high school shapes your interests and aspirations:

[M]y high school biology course didn't teach evolution. Without evolution, biology actually doesn't make sense, and instead it's just an anatomy class. ... I had no idea how fascinating biology actually was until I was an adult, and long past any chance of starting on that as a career path. Not that I think I would, but you can easily see someone like me making that choice as a young woman, but not really being able to because I was never offered that option in a realistic sense to begin with. 

(As someone who did study biology, and who loves Amanda's writing about science- and skepticism-related topics as much as I do her feminist writing, I can see it. Her interest in the subject is obvious, as is her commitment to find out what's true and how we know it's true. While she won't --- can't --- go into the kind of technical details I sometimes do here, her grasp of general, foundational principles is firm enough that I can easily forget she does not possess a biology degree herself.)


To shift to another aspect of why Drum's assessment is so horribly, horribly wrong, I quote PZ:

[T]his is going to be the century of dependence on the sciences. Climate change is going to hit us all; environmental crises are going to rise up all over the place; we're going to face shortages of energy and fresh water; emerging diseases will be a major concern; new biomedical technologies will cause cultural shocks; the whole world is going to change. Most people, I agree, will not be doing the research that leads to changes, and most of these problems will require political and social changes to correct, but how are you going to convince people to, for instance, change their fuel consumption habits when they're in complete denial of basic facts? How can you expect people to appreciate the importance of ecology and global interactions when you tell them that evolution doesn't matter? How will you get them to make rational decisions to control pandemics when they can't comprehend probability, epidemiology, and viral/bacterial evolution on even the most basic level? 

Most importantly, though, this utilitarian attitude that all that matters is what people can directly use in their day-to-day life is a denial of the Enlightenment and principles on which our country was founded. It's a rejection of the liberal idea that human beings should be well-rounded and informed individuals --- the informed citizenry that should be the foundation of a democracy. We can't expect everyone to be biologists or poets or political scientists, but we should expect that one outcome of a public education is an appreciation of the breadth of human endeavor, and at least a smattering of the fundamentals of a wide range of subjects, sufficient that, to make it practical again, students can make informed career decisions and understand a basic argument from evidence from an expert. We lack that now. And to wave away a simple but essential starting fact about our existence as unimportant is deeply offensive.     

I would add to his first paragraph that you don't have to wait for some futuristic nightmare scenario for these things to affect people's lives. Disease-causing bacteria are already becoming resistant to a whole lot of the antibiotics we use to fight them; lots and lots of species have disappeared or are disappearing; sensitive ecosystems are already being stressed, some to the breaking point by human activity, and humans are already failing to see why they should care***.

The picture he paints in that first paragraph has already come to pass, in the way that the proverbial camel is already in the tent, he just needs to take a few steps forward before it becomes obvious to everyone.

I would also add something else that I think denying evolution does: it makes it easier to think of humans as separate from, and above, the natural world and all those other animals. It allows us to think that what we do to it, to them, will never get back to us. 

(You don't have to deny evolution to get to that mindset, though: I see it arising just as readily from the erroneous view of evolution as a teleological process of development from simple to complex organisms, with humans sitting triumphantly at the apex. I've posted before about my annoyance with this picture of evolution.)

*This is what Andrew Sullivan, another famous political commentator whom I know to be obtuse, thanks to driftglass, an obscure political blogger who is quite acute**, has called belief in creationism a "cultural signifier" that describes the group membership of the believer rather than what that person actually believes about reality. That whole line of reasoning makes me queasy, but even if he is right that no one actually believes the Earth is six thousand years old and every animal species living on it was molded from clay and animated with the breath of a god, if that is what they decide shall be taught to children as fact, in place of the full history of life on Earth (as much of it as we know, anyway) and an explanation of how life on Earth has changed as Earth itself has changed, then those children grow up with a much poorer understanding of the world around them. An idea can have consequences in the real world whether people truly believe it or not; all they need to is act as if they believe it. Also, Andrew Sullivan is dumb.

**Hee. I made a geometry pun.

***This is not, at all, meant to be an exhaustive list, or even a primer on any of those subjects. I just put a recent news/research story in every link to make the point that, yes, this stuff is happening, and it's not just one or two isolated incidents. 

"I Don't Care If They Hit You; You're Not Supposed to Hit Back!"

(Photo by Allison Long, for the Kansas City Star)

A recent article in the Kansas City Star covered a group with a different sort of anti-bullying campaign: it's a boxing-based fitness class just for teenagers who've been bullied or whose friends have been bullied.

It's called Fight Club, and in general I think it's awesome. It sounds, in a lot of ways, like exactly what I needed in middle school.

There's only one thing that bothers me about the program: it's not an actual self-defense class. The article stresses that the kids taking the class are encouraged not to fight back against their abusers, and that the boxing serves more as an outlet for emotions than as practical training:

It's not a self-defense class. Holly Reynolds, the woman who started the program, can't call it that for legal reasons. It's not about fighting, either, though Reynolds gave it the same name as the 1999 Brad Pitt movie about underground fight clubs.

This Fight Club is about getting fit, feeling strong and fighting the good fight, she said.

These teens don't spar with each other. They spar with their feelings.

It's not that the things the classes do offer --- improved physical fitness, confidence, an emotional outlet, a roomful of other people who are having the same experiences as you, along with adult trainers and mentors who are clearly on your side --- aren't also hugely important; I just worry that explicitly discouraging these kids from fighting back if they're assaulted undermines what the program is supposed to do. It's supposed to give you confidence and enable you to stand up for yourself or your friends; how can you do that if you freeze up once the confrontation escalates?

We have a serious problem in mainstream American culture, in that we tend to put all the blame on victims of violence --- especially certain kinds of violence. If you were raped, you must've done something to draw attention to yourself, or gone somewhere you shouldn't have, or trusted someone you shouldn't have trusted. To use some philosophical terminology, the rapist may have been the immediate or proximate cause, but you were the ultimate cause of your own rape.

It's the same with bullying, whether of children in school or of adults in the workplace or in their communities. If one or more people decide to harass you, stalk you, follow you around in groups yelling things at you, try to scare you, subject you to unwanted, gross and insulting sexual advances, physically attack you or vandalize your property, it's bad, but you must've done something to make them choose you as their target.

And with school bullying, adults tend to tell children very stupid, unhelpful things when those children ask for help, like, "Just ignore them; they'll go away if you don't respond." (More victim-blaming: you're only being bullied because you let them get a rise out of you!) They also hold victims of bullying to a much higher moral standard than the bullies themselves: no matter how in-your-face, menacing or even violent they get, if you hit them back, you're just as bad as they are. They ignore bullying until it does turn into a physical fight, and when that happens, they act as if all combatants are equally at fault*.

So, against that kind of cultural backdrop, I don't think it's doing the kids any favors to try and convince them they don't want to hit the people who are abusing them. Of course they do. Telling them they don't, when they know perfectly well that they do, would (I think) just work to undermine any impression you've made of being the rare adult who understands what they're going through.

Don't get the wrong idea; I know teaching kids self-defense won't magically enable every one of them to win a fight with a bully (especially those who are bullied by a whole pack of people), and I know it's not fair to expect victims of bullying to solve the problem on their own. In my ideal school environment, teachers and bystanders would play a much more active role in defusing incidents of bullying; I just think physical self-defense is also a tool kids need to be given, without shaming or second-guessing them when they use it.

*That happens to grown women, too, when they try to defend themselves against rape or domestic abuse.

Born This Way

Some book I read a long time ago --- it may have been Steven Pinker's The Blank Slate --- maintained that, in the US, conventional wisdom has swung back and forth on whether differences between people that show up in adulthood have been present since birth, or whether they are acquired during childhood and adolescence.

It's usually intelligence that gets discussed in this way, almost always in the context of racist, sexist, or otherwise inequality-justifying theories about some groups being naturally smarter than others, but there's been a similar periodicity in thinking about other things, like personality traits. (Gender differences in cognitive style, interests, and personality are some of the things that are now widely believed to be present at birth; see Cordelia Fine's book Delusions of Gender for a lot more about these ideas' ubiquity and the still-ambiguous nature of the evidence they're supposed to be grounded in).

Right now, I want to talk about how this idea has gotten established in two different subcultures to which I belong: the autism community* and the gay community.

Autism and homosexuality have somewhat similar recent histories in US culture: both either are, or have been, considered mental disorders, both were thought in the 1950s and early '60s to be caused by some warping of the normal bond between mother and child (either, as with autism, too much distance between them, or with male homosexuality, not enough), and papers from the 1960s, '70s and '80s document various attempts to "treat," with aversion therapies that would now be considered abusive, children showing signs of either one. (One researcher even worked on both projects: O. Ivar Lovaas, who has done famous, if controversial, work adapting Applied Behavior Analysis (ABA) for use with autistic children, has also co-written several articles about "feminine boys," and using ABA to normalize their behavior).

Homosexuality was removed from the DSM in 1973, but there are still people who consider it (or anything deviating from straight, married monogamy, really) a pathological condition, and therapists who specialize in trying to turn gay people straight.

In contrast to that idea --- that gay people can change, and therefore should change --- the gay-rights movement has embraced the idea that sexual orientation is inborn. (And most mental-health professionals, including groups like the American Psychological Association, the American Psychiatric Association, the American Counseling Association, the National Association of Social Workers, and the American Medical Association, pretty much agree with them that no sexual orientation is inherently pathological, and that you can't change a person's sexual orientation through therapy).

The picture is somewhat different for autistic people. Not only is autism still considered a disease, and a pretty serious one, by almost everybody, but the idea of innateness, when it comes to autism, doesn't have the same implied corollary of "... and therefore you should accept us the way we are" that it has in reference to sexuality.

No, the shift from "psychogenic" to "biogenic" theories of autism happened for two reasons: first, and probably most important, the evidence (what little there was in the early '60s) didn't fit well with the psychogenic model**, and fit better with the biogenic one; another factor was activism by parents, who were fed up with being blamed for their children's condition, and who called for more research into potential biological causes.

Here, Boston University law professor Daniela Caruso, who has written an article on the history and legal impact of autism advocacy in the US, describes the relationship between the nascent field of biomedical research into autism and the beginnings of the US's major autism-advocacy groups:

It was only in 1964 that Bernard Rimland put forth an alternative explanation of the syndrome, based not on psychodynamics but rather on neurobiology. In 1965, Rimland founded the American Society for Autism (ASA) which is, to this day, a major center of advocacy.

Following Rimland's work, activism in the name of autism began to flourish thanks to both grassroots efforts and power houses. Some groups - most visibly Cure Autism Now (CAN) and the National Alliance for Autism Research (NAAR) - coalesced around genetic research and investigation of toxic substances potentially related to the surge of autism. It is no coincidence that such movements emerged in a context of burgeoning environmental activism. Many other capillary initiatives focused instead on the reality of living with autism by developing information centers for parents of newly diagnosed children, and starting awareness campaigns aimed at educating the public about this poorly-understood phenomenon.

(See also: this post, which discusses another article on the history of autism advocacy in the US. I also found another recent article about the role of parent activism throughout the history of autism, but I can't get at the full text of it).

I also found this snippet in Rimland's book itself (that part of it I could see on the Internet, anyway; I don't own the book), discussing why he thought so many researchers were reluctant to consider the possibility that autism had a biological basis:

In discussing the obvious prejudice against the hereditary viewpoint, Nolan Lewis (1954) points out, "It would seem that most of the prejudice against genetic inheritance stems from a feeling in the realm of wish fulfillment, based on the idea that acceptance of genetic factors would create an attitude of therapeutic hopelessness." Williams (1956) cites this point among others in his attempt to penetrate the prejudice against heredity. He notes that hopelessness is by no means justified by the evidence, and cites the ready correction of diabetes, phenylketonuria and hypothyroidism as examples.

So, that's kind of interesting --- that, at the outset, there was reluctance to adopt a conception of autism as innate and biologically based because of worries that that might mean it was impossible to eradicate through treatment --- but the answer to that wasn't, "so let's not try to make them non-autistic, let's just try to integrate them into society to the best of our, and their, ability", it was "don't be silly, of course we can make them non-autistic!"

I'd also want to point out that the two competing narratives of autism came from the same source: medical professionals, whether psychoanalysts or biomedical researchers. This is in contrast to the two competing narratives of homosexuality, one of which came from medical professionals and the other of which came straight (heh) from the people they were trying to describe. It wasn't until much later that autistic people's own viewpoints were even known to exist, much less taken into account by medical professionals and policymakers.

So, while as far as I know most autistic people do think they were born autistic, that idea doesn't have the same liberatory subtext for autism that it has for sexual orientation. (Indeed, the switch over to a mainstream view of autism as innate and biologically based had already happened when research into "extinguishing" autistic behaviors was at its peak.) The biggest thing it did was to free parents from guilt at having caused the autism, which is important and was definitely needed, but it left the position of the autistic people themselves unchanged.

*I'm using that phrase --- instead of "the autistic community" --- because I am mostly talking about parents. I've made this distinction before: the autism community, which includes parents/caregivers, healthcare workers, autism researchers, and educators; and the autistic community, which is the autistic people themselves. Sometimes the latter group is included in the former, but mostly it is not, and sometimes the two groups are at odds with each other.

**See Chapter 3 of Rimland's 1964 book, Infantile Autism, for a discussion of what those findings were and how they conflicted with the psychogenic model of autism.

Autism Diagnoses Spread through Social Networks

EXECUTIVE SUMMARY: A little more than a year ago, a group of sociologists analyzed data from the state of California --- birth records and records from California's Department of Developmental Services --- to look for patterns in where autistic children were most likely to be found. They determined that children living near (defined here as being within 500 meters) a family where one of the children had been diagnosed with autism in the previous year were somewhat (1.26 times) more likely to receive an autism diagnosis themselves. They also found that 1) the effect was stronger for the less severe cases of autism, and also for children who were three years old when they were diagnosed (as opposed to 4, 5, or 6); and 2) children living very close to a family with a recently-diagnosed autistic child were about 28% less likely to be diagnosed with intellectual disability without a concurrent diagnosis of autism. The researchers concluded that parents who know other parents who've had a child diagnosed with autism are more likely to have their own children evaluated, and thus more likely to get a diagnosis for their own children.
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An article published last year in the American Journal of Sociology argues that knowing someone in your neighborhood who has an autistic child makes it likelier that your child, too, will be diagnosed with autism.

The authors' explanation for this is not that autism is "catching," or that people with autistic children are likelier to live in certain places (they investigated both of those possibilities, along with the possibility that some environmental contaminant makes some neighborhoods have more autistic children than others); it's that parents talk to each other about their children, and if one family has an autistic child, and has gotten that child diagnosed and enrolled in services, those parents will tell other parents about that process, and thereby make it easier for other parents to do the same thing. (They may also, by describing their autistic children's behavior, make it more likely that other parents will consider the possibility that their child may be autistic).

What these researchers --- sociologists Peter Shawn Bearman, Marissa D. King (who has conducted a lot of research into autism demographics) and Ka-Yuet Liu --- did to derive this explanation was look at data on all children born in California since 1997, with younger siblings also born in California. (They needed to restrict their sample to children with younger siblings to get information on where the firstborn children spent their early years --- if the family's residence is the same for every child born to that family, the researchers could assume that the firstborn lived in the same place during the years between hir own birth and the birth of hir youngest sibling. That's the information they wanted --- where families lived during their children's early years). This gave them a pool of 533,244 children whose families lived at the same address when they were born as when their younger siblings were born. Then, they used data from the California Department of Developmental Services (I've written about this data set before, in a different context --- it's been used in a lot of studies investigating autism prevalence) to determine which of those children got an autism diagnosis, or a diagnosis of intellectual disability*, between the ages of 2 and 6.

They created a statistical model to see if they could accurately predict which children would end up with a diagnosis of Autistic Disorder**. Their model, which is supposed to predict the odds of any given child being diagnosed with autism in a given year, t, uses the physical proximity of a child diagnosed with autism in the previous year, t - 1, as its predictive variable. They divide this continuous measure --- how far away does [other child with autism] live? --- into six discrete groups: 1 - 250 m; 251 - 500 m; 501 m - 1 km; 1001 m - 2 km; 2001 m - 5 km; and all distances over 5 km. (They used a continuous measure of distance, too). They controlled for a slew of other variables --- sex, maternal age, socioeconomic status (measured by mother's educational attainment and whether she received state assistance with pregnancy- and birth-related medical expenses), proximity to autism-related healthcare services, neighborhood population density, and neighborhood median income --- and predicted that the odds of a child being diagnosed with autism would increase the closer they lived to a child already bearing that diagnosis, and that the odds of a child being diagnosed with intellectual disability independent of any other condition would decrease with increasing proximity to a child diagnosed with autism. They also predicted a pattern in what kind of autistic children would show the greatest change in likelihood of diagnosis: they thought that the "high[est]-functioning" children, who scored the lowest on their measure of autism severity***, would show the greatest effect, along with the youngest children (age 3 or younger). Their reasoning is that, since these are the most ambiguous cases, whether or not their parents knew someone else with an autistic child, and thus got it into their heads to consider whether their child might also be autistic, would make the most difference, since there are less likely to be really obvious, textbook signs of autism. (Or, if signs are present, say, in the very young children, knowing another family with an autistic child might predispose the parents to have their child evaluated sooner, rather than waiting to see if, say, the child is just a late talker).

Sure enough, they found the patterns they'd predicted.

This graph shows the clustering of actual data points around their theoretical curve; you can see it's a pretty close fit.

(Figure 2A, in Bearman, King and Liu, 2010. The x-axis shows distance, in kilometers, from the nearest home with a child with an autism diagnosis, and the y-axis shows the probability that any given child living at that distance will be diagnosed with autism within the next year).

Here's a different representation of the same data:

(Figure 2B, in Bearman, King and Liu, 2010. The x-axis still shows distance, but the y-axis, instead of showing probability of an autism diagnosis in the next year, now shows the odds ratio between each distance category and the reference category, which is 501 m - 1 km. The five different dots in each distance category represent the five different statistical models that were used. You can see that, compared to the middle distance category, the children in the two shorter-distance categories were more likely to receive autism diagnoses, while the children in the three longer-distance categories were less likely to be diagnosed.)

From the Results section:

[W]e also report the effects of proximity as a categorical variable. All odds ratios (ORs) are relative to the reference category of 501 meters - 1 kilometer. ... In figure 2B, we can observe that residing in close proximity to a child diagnosed with autism increases one's chance of being diagnosed with autism in the subsequent year. Compared with children who are 501 meters - 1 kilometer away from their nearest neighbor with autism, those in close proximity (1 - 250 meters) to a child with autism have a 42% higher chance of being diagnosed with autism in the subsequent year. Proximity of 201 - 500 meters increases the chance by 22%. In contrast, being farther away from a child with autism reduces the chance of a diagnosis. Although the last three categories were all significantly associated with the decrease (-21%, -36%, and -49%), there were no statistically significant differences among these three categories. This is consistent with the results in figure 2A, which show that the effect of proximity is strongest within one kilometer, followed by a flat tail.

And here are the graphs showing the effects of proximity to a family with an autistic child on 1) a child being diagnosed with autism (with intellectual disability) rather than with intellectual disability alone ...

(Figure 2C, in Bearman, King and Liu, 2010. The x-axis shows distance; the y-axis shows odds ratios --- compared, again, with the middle-distance "reference" category of 501 m - 1 km --- of being diagnosed with intellectual disability by itself. You can see that living closer to a family with a recently-diagnosed autistic child made it less likely that a given child would be given a sole diagnosis of intellectual disability, although it is only at the farthest distances, 5 kilometers or more, that children become more likely to receive a diagnosis of intellectual disability independent of any other condition).

... and 2) being diagnosed with autism at varying levels of severity:

(Figure 3, in Bearman, King and Liu, 2010. The x-axis shows the percent increase in odds of receiving an autism diagnosis associated with proximity to a recently-diagnosed autistic child; the y-axis shows the child's level of disability as assessed by the state's Client Development Evaluation Reports. The highest-scoring, or least impaired, 20% are compared to the bottom, or most seriously impaired, 20%, and to the middle 60%. You can see that the "highest-functioning" group shows a stronger effect of proximity to another autistic child on their chances of being diagnosed than either the middle group or the "lowest-functioning" group, whose chances of being diagnosed with autism were least affected by proximity to another recently-diagnosed autistic child.)

The researchers were pretty well satisfied that the effect they found for proximity wasn't an artifact of shared environmental contamination because they saw the same pattern in a large, diverse sample of neighborhoods. They looked at rural, urban and suburban communities, which would all have their own distinct toxicological profile. (For instance, pesticide exposure would be a likely risk factor in rural areas, and a possible one in suburban areas, but pretty unlikely in urban areas. Similarly, air pollution is probably only a serious factor in dense urban areas.) There were other patterns that would not be explained by shared environmental risk factors or viral transmission, but that do fit with the social-diffusion hypothesis: first, a strong tendency of people coming in for diagnostic evaluations to have been referred there in the way as their nearest neighbor with an autistic child, and second, for people living on or near a border between school districts, the proximity effect was only seen for children living nearby who also attended school in the same district.

So, I find all this pretty supportive of their idea that social networks play a role in determining who is and who is not diagnosed with autism; what is less clear to me is how much of a role they play compared with other factors, like socioeconomic status, parents' ages, male gender, or having an autistic relative.

What Drs. Bearman, King and Liu did to try and answer that question is calculate the population attributable fractions (PAFs) --- the difference any given risk factor makes in the number of people who develop a certain condition --- for proximity to another autistic child, and also for each of three sociodemographic indicators: mother's age at the time of her child's birth, mother's educational attainment, and whether the state of California paid for her prenatal and obstetric care. By this metric, they found a greater role for proximity than for any other factor: living within 500 meters of a family with a recently-diagnosed autistic child raised children's likelihood of being diagnosed with autism in a given year by 16%.

While this may be a larger effect than any of the other, more-established risk factors, it's not larger by all that much, and in absolute size it's also not very big. I would expect that, though --- most children don't have autism, so the most a social diffusion of autism awareness could do is make the parents of those children who do have autism take them in to be evaluated sooner. (Or, maybe for a few families, at all --- but with schools getting more and more proactive about identifying special-needs children, it's not very likely anymore that a child with autism could get all the way through K-12 without being flagged somewhere along the line).

Liu KY, King M, & Bearman PS (2010). Social influence and the autism epidemic. AJS; American journal of sociology, 115 (5), 1387-434 PMID: 20503647

*They tracked this category as well to look for social/spatial patterns of diagnostic substitution --- are children who are more likely to be diagnosed with autism also less likely to be diagnosed with general (i.e., non-autism-associated) intellectual disability?

**They only counted children in this category, and not any other pervasive developmental disorder, because only Autistic Disorder is a category eligible for state services. The researchers felt that parents' main motivation in pursuing a diagnosis would be to gain access to services, so they didn't bother tracking the diagnoses that wouldn't be useful toward that end.

***Their severity measure involved nine items from the California DDS's Client Development Evaluation Report (CDER) on each child. (Here is a PDF of the complete CDER form, if you want to go and look at what exactly these items are measuring). The overall measure was an equally-weighted average of scores on three "scales" --- communication (made up of 3 CDER items: item # 58, word usage; item # 61, receptive language; and item # 62, expressive language), social interaction (made up of 5 CDER items: item # 27, peer interaction; item # 28, interaction with nonpeers; item # 29, friendship formation; item # 30, friendship maintenance; and item # 31, participation in social activities), and a single CDER item, # 42, measuring repetitive and stereotyped behaviors. (I find it a bit odd that they didn't include self-injurious behavior as part of their severity measure --- there are two items on the CDER addressing that, and the presence or absence of self-harm seems to me a more important measure of how "severe" someone's problems are than, say, being able to interact "normally" with one's peers.)

Poll Data on Vaccines Looks Contradictory, But Isn't

Yesterday I ran across two seemingly contradictory factoids about public opinion on the autism-vaccine issue: this column in this month's Scientific American cites a poll* finding that just under half of U.S. adults either believe vaccines cause autism or aren't sure whether they do or not, while Left Brain/Right Brain reports on survey data** analyzed in two articles (full text here and here) in Pediatrics that found 79% of U.S. parents believe vaccines are safe.

So, which of these is true?

I'll start by pointing out that the subset of people who said they were "not sure" about the vaccine-autism issue could probably also fall into the subset of people who said they thought vaccines were safe in the other survey --- people's positions on issues can be pretty elastic, depending on how questions are asked and what kind of answers they think the pollsters want to hear. I think people who fall somewhere in the middle might have even more wiggle room than those who come down more strongly on one side or another.

The undecided group in the Harris/HealthDay poll, at 30% of respondents, was quite a bit bigger than the group professing a belief that vaccines cause autism (18%).

Thus, the proportion of all people who don't actively believe that vaccines cause autism in that survey is 82%, similar to the 79% of people who said they considered vaccines to be safe in the survey from two years ago.

Also, the two surveys sampled slightly different subsets of the U.S. population: the Harris/HealthDay poll was open to anyone over 18 (n = 2,026), while the two Pediatrics articles restricted their data set to respondents with minor children (n = 1,552). One of the articles went further, using only data from parents of children younger than 6 (n = 475).

Compared with the general population of the U.S. (reflected in 2010 census data), the group of people studied in the two Pediatrics articles is younger (the all-parents group was split about 60/40 between people under 40 and people 40+; two-thirds of the parents of young children were under 35; in the U.S. as a whole, a little less than half of all people, and about 60% of all adults, are older than 40), a lot richer and more likely to be female (split about 60/40 in favor of women).

What most interested me was the implication, in the article on parents of young children, that some of the people who think vaccines are generally safe, and believed vaccination was important for a child's health, are also worried that vaccines might cause autism:

Parents reported their attitudes regarding the safety and necessity of vaccines (Tables 2 and 3). The majority of the parents were either confident or very confident in vaccine safety (79.0%) and believed that vaccines are important to children's health (79.8%). Similarly, 73% of parents somewhat or strongly believed that the benefits of vaccines outweighed the risks. ...

Parents were asked to respond to a series of 11 potential vaccine-related concerns and were also given the opportunity of stating that they had no vaccine-related concerns (Table 4). Just more than one-fifth (20.8%) of the parents reported that none of the 11 issues listed were of concern to them. The most common concern reported by the parents was that it is painful for children to receive multiple shots during 1 doctor's visit (44.2%). Other concerns reported by >25% of the parents included their child receiving too many vaccines in 1 doctor's visit (34.2%), vaccines causing fevers in their child (28.3%), children getting too many vaccines in their first 2 years of life (27.8%), and vaccines causing learning disabilities such as autism (26.2%).

The article's authors suggest that these parents are probably weighing the potential risk of autism against the protection from disease, and choosing to vaccinate despite their misgivings because they think the benefits outweigh the risks. (Data from the Harris/HealthDay poll would also tend to support this idea of a cost-benefit analysis; even among people who believe that vaccines can cause autism, a majority thinks schools should require children to be vaccinated).

The other article, the one that studied all parents of minor children, also looked into what sources parents considered credible in the matter of vaccine safety.

Overwhelmingly, the person they trusted most was their children's doctor (76% said they trusted their children's doctor "a lot," 22% said "some" and only 2% said they did not trust their children's doctor); just as overwhelmingly, people put very little stock in what celebrities have to say about vaccine safety (in a clean reversal of the figures for doctors, 2% of parents said they trusted celebrities "a lot", 24% said they trusted them "some", and 74% did not trust them at all). For all the other types of people --- health-care providers apart from their children's doctor, government officials, friends and family, and parents who believe their children were harmed by a vaccine --- most people said they felt "some" trust. Similarly, of the people who look at media relating to vaccine safety, most placed "some" trust in all of the media categories listed: medical organizations' websites (the only category that also had a large number of people saying they trusted it "a lot"), government websites, newspaper or magazine articles, TV, vaccine manufacturers' websites and anti-vaccine websites.

These survey results suggest to me that people aren't the gullible sheep skeptics often accuse them of being. They are wary of anecdotal evidence, give more weight to experts' opinions than to laypeople's, and give the most weight to those authorities they consider neutral, or to have their child's best interests specifically in mind. Also, even without an extensive grounding in virology, immunology or epidemiology, they seem to grasp the importance of universal vaccination in maintaining herd immunity.

People are wiser than the conventional wisdom gives them credit for being.

Freed, G., Clark, S., Butchart, A., Singer, D., & Davis, M. (2011). Sources and Perceived Credibility of Vaccine-Safety Information for Parents PEDIATRICS DOI: 10.1542/peds.2010-1722P

Kennedy, A., Basket, M., & Sheedy, K. (2011). Vaccine Attitudes, Concerns, and Information Sources Reported by Parents of Young Children: Results From the 2009 HealthStyles Survey PEDIATRICS DOI: 10.1542/peds.2010-1722N

*Poll conducted by Harris Interactive and HealthDay, on January 11-13, 2011

**The annual HealthStyles survey, conducted by the CDC and the public-relations firm Porter Novelli, throughout the month of January in 2009