Autism is not a defense mechanism

Autism is not a defense mechanism—we do not need to be cured!

Today, I had an appointment with a Swiss psychiatrist. He was to put his signature on my autism diagnostic report made by a psychologist on his team.

Dr. Engelbrecht’s screening report was instrumental in the ability of the psychologist to issue something readable for me. Though she is a licensed clinical psychologist, she had no experience in writing an autism assessment. Despite interviewing me once a week for 2 months, she had to copy-paste Dr. Engelbrecht’s evaluation findings.

Defense mechanism?

I spent 90 minutes in the psychiatrist’s office, where he read to me the diagnostic assessment drafted by the psychologist. He stated that it was normal for me to develop autism due to my father leaving when I was one month old. Shell-shocked by his words, I told him that autism was unlikely to be triggered by any event of toddlerhood—autism is an inborn neurodevelopmental disorder. He then replied that autism is a defense mechanism put in place by the child in adverse caregiving settings.

I let him know that some research showed that the autistic brain’s structure develops in the fetus. He exclaimed, “Indeed! Suppose the relationship between the parents is abusive. The mother is stressed by fear of her husband or her environment. In that case, you can be sure that it will affect the brain development of the baby!”

Adaptations

From Embrace Autism, I know that it is common to find family members with personality disorders with a similar genetic likelihood as the heritability of autism [heritability estimates of personality disorders range from 79% to 28% (median 61%),^[1]The Behavioral Genetics of Personality Disorder (Livesley & Lang, 2008) compared to an estimated 64–91%^[2]Journal of Child Psychology and Psychiatry Journal of Child Psychology and Psychiatry Original Article Open Access Heritability of autism spectrum disorders: a meta-analysis of twin studies (Tick et al., 2015) or 83%^[3]The Heritability of Autism Spectrum Disorder (Svandin et al., 2017) in the autistic population]. Dr. Engelbrecht suggests that personality disorders are an adaptive mechanism in society to ensure that the species perform optimally. As with autism, each personality disorder has advantages and disadvantages.

But the psychiatrist continued to insist that autism is unconsciously learned as an adaptive trait among unavailable or harmful care-takers who failed to be “good enough” (Winnicott’s research on the Good Enough Mother).^[4]Introduction to The Child, the Family, and the Outside World (Winnicutt, 1964) I was curious if he saw autism as a condition needing to be cured, so I asked him, “So, if you consider autism as a reactive condition developed in bad parenting settings, do you think that autism can be cured?” He replied, “Absolutely! As I do think that pedophiles and other criminals can be cured.”

I regret that no photograph documented my face and my body language at that moment—I unwittingly displayed something like disgust, desperation, and annoyance. I said, “Well, it seems to me that your stance is ableist. You have the right to think as you will about autism, but this is ableist as far as I’m concerned. You see autism as an illness that can be undone or cured. More importantly, you think that autism is a maladaptive, neuro-developmental personality trait”.

He opposed my view, saying that he would not be a physician if he were ableist and would not praise Greta Thunberg’s activism. I think I could not help but laugh in front of him; I hope I only chuckled, but I am not sure. He continued, “Do not get me wrong… autistic people are not worse or better than others. They suffer as a result of their family’s trauma, and they can be cured through the healing of that trauma.”

After reflection, I asked him, “Even if someone develops autism as a coping mechanism, once autistic traits are developed and stabilized, don’t you think that an autistic person can pass on autism to their child despite being a ‘good enough’ parent?” He replied: “Well, if the relationship between this autistic caregiver and their partner is bad, they can’t be good enough for the child.”

I continued, “So for you, no autistic child can be the result of good enough autistic or neurotypical parents?” He vacillated but replied, “We all are autistic in a way. We all had to defend against traumatic experiences from our childhood. Even if the parents of the autistic child are good enough, the child is not autistic by accident and may replay a trauma coming from his grandparents or great grandparents.”

Then, he held forth about psychoanalysis techniques and how powerful they are in resolving autistic “noodles” (a metaphor for the brain) made of neurosis and psychosis inherited from parents. And, how brilliant was the work of an Argentine psychoanalyst, Bruno Bettelheim (August 28, 1903 – March 13, 1990), who “cured” autistics.^[5]Bruno Bettelheim, Autism, and the Rhetoric of Scientific Authority (DeMaria Severson, Jodlowski & Aune, 2005) This is despite much of Bettelheim’s work being discredited after his death due to fraudulent academic credentials, allegations of abusive treatment of patients under his care, accusations of plagiarism, and lack of oversight by institutions and the psychological community. After a few painful minutes of hearing about Bettelheim’s success in curing autistics, I had to stop him, saying that MRI did not exist at that time. If they did, physicians would know that being autistic has to do with unique patterns of brain circuitry as compared to NTs.

I also said that, to me, believing that autism can be cured is an ableist bias. Then, he tried to appease me, saying that it was not a question of curing autism but rather to “end the suffering” of autistic people. I told him that the suffering of autistic people was, by and large, the result of their unknown differences plus the challenges with interactions they have with NTs. This is in large part due to practitioners failing to make proper diagnoses. If autistics were able to receive a proper diagnosis, it would allow them to understand their differences and get the support they need. This is especially true for autistic females with no intellectual disability.

I tried to introduce the double empathy problem.^[6]On the ontological status of autism: the ‘double empathy problem’ (Milton, 2012) He did not understand and insisted that I needed help and therapy to cure my suffering of autism. He had shifted from “curing the autism” to “cure the suffering of autism.” I tried to set out for him how a biological trait/condition developed under adverse circumstances could be passed on under the most favorable circumstances to a child and their siblings. I also tried to point out that, according to his reasoning, good parenting and good upbringing circumstances could not help but lead to a neurotypical child.

He refused to agree with my conclusions but conveniently stated that we were saying the same thing. I corrected him, saying that we did not say the same thing. He never accepted my viewpoint of autism as an inborn difference, not as an inherited disorder. Then, he had the temerity to inform me that he identified a drug that would be helpful and that he would talk to me about it in our next appointment. Can you believe it? The same clinician who failed to identify my autism in the first place is now purporting to cure it for me!

This medical advice comes from a psychiatrist who does not want to cure autism—only “autistic suffering”. A psychiatrist who is not ableist—he only believes that autism is a defense mechanism. A psychiatrist who is neither arrogant nor incompetent but thinks he knows better than me what is good for me. All the while simultaneously acknowledging that I have successfully managed to take care of myself, heal my alexithymia, and figure out my autistic condition without any professional medical assistance.

Instead of him expressing regrets about the awful medical journey I had to undergo before being correctly diagnosed and rejoicing for me and my achievements in improving my mental health, he belittled my accomplishments. He subverted my sense of relief by stating that I had a lot more to do, and needed to be serious about healing my trauma through therapy with his psychologist colleague. Thank God I only need his signature on a piece of paper; once I get it, he will never see me again!