Wednesday, May 2, 2012

Autism and the art of campervan maintenance



Back in February, we spent a relaxing two weeks cruising around the North Island of New Zealand in a campervan, quickly christened Campo by my four-year-old. We saw the giant Kauri trees of Waipoua and the giant sand dunes on 90 mile beach; we went sailing on the Bay of Islands and bathing in the volcanic springs of Hotwater Beach. And it only rained twice. I learnt a little of the art of campervan maintenance [1]. And, while I was under strict instructions not to do any work, the winding roads of Northland and Coromandel gave plenty of opportunity for idle philosophising.

For holiday reading, I picked up a copy of Richard Dawkins' The Greatest Show on Earth, in a lovely little second hand bookshop in Devonport. Dawkins, it must be said, is on top form, laying out the evidence for evolution and laying into creationists and flat-earthers at every turn. The highlight for me was his joyful description of Lenski’s experiments in bacterial evolution. Even for someone far removed from this line of research, it’s inspirational stuff, demonstrating the elegance and power of science done well.

The dead hand of Plato

In Chapter 2, Dawkins ventures on an interesting tangent, asking why it took us all so long to figure out evolution. After considering some of the more obvious explanations (religious objections, the unimaginable timespan of evolution), he ultimately concludes by laying the blame at the feet of the ancient Greek philosopher, Plato [2].

Plato’s idea was that all classes of things have an essence – a set of defining properties. Members of that category may vary in other respects, but they all share that essential nature. Chairs, for example, can vary in size, shape, colour, comfort, and so on, but they are still all essentially chairs; they all have the essence of chairness; they are variations on an ideal chair.

As the evolutionary biologist Ernst Mayr pointed out, this essentialist way of thinking about things becomes problematic when trying to understand evolution. Plato would consider any natural variation amongst rabbits as "flawed deviation from the ideal essence of rabbit". In Mayr's view, Darwin succeeded by breaking away from this Platonic mindset and realising that it is this variation, coupled with non-random selection, that is the driving force behind evolution. For Darwin, there was no essential quality of rabbitness; no ideal rabbit; and, crucially, no guiding hand directing historical proto-rabbits to become more rabbit-like.

Giant Sandunes, Northland

Dawkins concurs with Mayr, and spends the rest of The Greatest Show on Earth piling on the evidence for evolution from every conceivable angle. The relevant point here, however, is that natural selection is counterintuitive. Our default mode of thinking in terms of essential, idealised qualities of different species proved an obstacle to scientific progress. This probably explains why Darwin was so late on the scientific scene; why he wasn’t beaten to the punch by a scientist centuries earlier. It probably also goes some way to explaining why so many people today still deny the possibility of evolution, in spite of the overwhelming evidence. It’s an illustration that our intuitions are often wrong or misleading and that the whole point of science is that it can and frequently does defy those intuitions [3].

The essence of autism

I was trying hard not to think about work. But as I read about Plato, Mayr, and the essence of bunny rabbits, it struck me that there might be important lessons for autism research. It's not that there are any obvious analogies that I can think of. But, like Darwin's contemporaries, I wonder whether we, as people interested in autism, may be stuck in a similar essentialist rut. 

Cape Reinga - where the Tasman
meets the South Pacific
The following, from a recent post on the SFARI blog, expresses a familiar sentiment:

"Autism is a complex, heterogeneous disorder. But the core phenotype, which can be recognized to some degree in any individual on the autism spectrum, nonetheless suggests that there must be some common underpinnings.”

We acknowledge the heterogeneity within autism, but our intuitions still drive us to seek a common essence of autism. 

It’s easy to see where this intuition comes from. Essentialism underlies our definitions of autism. Diagnostic criteria are aimed squarely at defining the “core” (essential) characteristics of the disorder. We can even think of an "ideal" autistic person as someone whom Kanner would have identified as autistic – someone with "classic autism". Diagnostic boundaries indicate how much variation away from this ideal can be tolerated before the individual is deemed to be not autistic. Common symptoms that are not part of the diagnostic criteria, such as language delay, intellectual disability, attention deficit, and so on are considered to be non-essential “co-morbidities”, separate and on top of the autism.

The essentialist view of autism goes hand in hand with the way autism research is conducted and reported. Most studies involve taking a group of individuals with autism and comparing them to a control group. The assumption is that the group average is what matters. Individual differences within the autism group are considered to be non-essential variation.

Sandspit estuary

Studies are then reported as showing, for example, that people with autism are good or bad at a particular test, that their brains are over- or under-activated in response to a particular stimulus, or that they do or do not respond to a particular intervention. This kind of generalization, from the handful of individuals taking part in the study to "people with autism", is only licensed if people with an autism diagnosis are interchangeable - if they are essentially the same. Yet one only has to meet a few to realise that this is not the case.

Universals and specifics

Perhaps most clearly and explicitly, the Platonic mindset is revealed by the widespread view that theories of autism must be evaluated according to their universality and specificity; the theory should apply to everyone with an autism diagnosis but nobody without autism and failure on either of these criteria is grounds for rejecting a theory.

A recent exposition of this view comes from a paper by Kevin Pelphrey and colleagues in a paper criticising the "underconnectivity" account of autism:

Seriously good fush and chups
"it is not yet clear how the underconnectivity perspective accounts for the specific patterns of dysfunction in individuals with ASD. That is, how might this perspective explain what is common among individuals with ASD and what separates ASD from other neurodevelopmental disorders that also feature underconnectivity?"

This is certainly a valid criticism insofar as proponents of "underconnectivity" sometimes portray it as a theory-of-autism, conveniently ignoring the evidence for atypical connectivity in other disorders. But Pelphrey et al.’s alternative is to look for the essence of autism elsewhere - in the brain mechanisms underlying the "core disruptions in social information processing". Notably, none of the evidence they review from their own research comes close to universality or specificity either.

The problem doesn’t just apply to brain imaging studies. At every level of analysis, from genetics and neurobiology through to cognition and behaviour, there is variation within autism and overlap with other disorders. This all tends to undermine the fundamental underlying assumption that there is this discrete thing called autism that people either do or don’t have. This isn’t the same thing as saying that autism doesn’t exist - any more than Darwin was proposing the nonexistence of rabbits. But it does suggest that we need to change the way we think about and research autism.

Variation in individuals

Tane Mahuta - I'm standing at the bottom,
boy on shoulders
There are certainly moves in this direction, with increasing interest in autism subgroups, individual variation, and cross-diagnostic comparison. Perhaps the most radical new approach was recently announced by the Simons Foundation. The Variation in Individuals Project is looking at deletions and duplications in region 16p11.2 of chromosome 16, which has been linked to autism, developmental delay, schizophrenia, and bipolar disorder. But rather than looking only at people who meet criteria for a particular condition, participants are being recruited regardless of their diagnosis.

This I think is beginning to approach the crux of the problem. Ultimately, “autism” is a label for a set of behaviours. By always beginning with autism and working backwards, we have invested too much significance in the label itself.


Postscript

Another bookshop, this time back in sleepy old Brooklyn, New South Wales. Hiding behind the anniversary edition of The Selfish Gene is a small battered copy of The Common Sense of Science by Jacob Buronowski. Flicking through, I stop on page 62.
“In many scientific problems, the difficulty is to state the question rightly; once that is done it may almost answer itself.”


Notes:

[1] The main thing I learnt (and it took me a week to figure this out) is that, on a Toyota Hiace, there's a hidden clip that allows you to lift up the passenger seat and get to the engine. But this is really a reference to Zen and the Art of Motorcycle Maintenance, which is a book about a guy crossing America on a bike, pondering the meaning of the word "quality". I've come to the conclusion that "autism" is equally intangible.

[2] This from our resident philosopher, Prof John Sutton: "In terms of actual historical influence, Plato's extreme and other-worldly essentialism was less influential than Aristotle's version. Aristotle entrenched the idea that biological species are eternal, which didn't help, even though his paradigms or essences were more like prototypes than non-physical forms."

[3] I love this quote from Elizabeth Spelke. “I don’t place much faith in my intuitions, except as a starting place for designing experiments.”


Cathedral Cove



References: 

Brock J (2011). Commentary: Complementary approaches to the developmental cognitive neuroscience of autism--reflections on Pelphrey et al. (2011). Journal of child psychology and psychiatry, and allied disciplines, 52 (6), 645-6 PMID: 21574994 PDF

Pelphrey, K., Shultz, S., Hudac, C., & Vander Wyk, B. (2011). Research Review: Constraining heterogeneity: the social brain and its development in autism spectrum disorder Journal of Child Psychology and Psychiatry, 52 (6), 631-644 DOI: 10.1111/j.1469-7610.2010.02349.x PDF

Simons Vip Consortium (2012). Simons Variation in Individuals Project (Simons VIP): a genetics-first approach to studying autism spectrum and related neurodevelopmental disorders. Neuron, 73 (6), 1063-7 PMID: 22445335


Further reading:

34 comments:

  1. Great post. Evolution is mindblowing stuff when you appreciate the scale and its implications for individuals, it's like an acid trip, it's not a viewpoint you can hold for long. I think any such awareness, however brief, of a bit of reality forces us to recognise our limitations: that we aren't platonic reckoning machines, that there isn't an ideal person and disordered versions thereof, and that any models we come up with will be more like sculpture carved from Nature's data in the image of ourselves than reflective of Nature itself.

    Most interesting autism 'result' for me was this: http://www.psychologytoday.com/blog/experiments-in-philosophy/200811/do-you-have-aspergers-syndrome - saying here are two opposing ways of viewing our tiny human experience and most autistics see things one way and most nonautistics see things another way. In my opinion, anyone not humbled by that hasn't thought enough about evolution (or taken enough acid).

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    1. Ha. So to "solve" autism, we should all take more acid?? :)

      Thanks for the link

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  2. What an insightful post. Informative and great fun to read. Essentialism, the human tendency to believe in ‘essences’, in something permanent that is core to a concept, is up for serious criticism. But to change, even with persuasive arguments, is an uphill way.

    Whenever I read a critique of essentialism I wish I was better than I am and could shed my own essentialist beliefs. Perhaps I will see the light some day. Meanwhile I remain a Platonist. For autism research I can see a few advantages in essentialism. For example, it acknowledges and explains the psychological experience of the 30-second diagnosis, and the clinical intuition of a perceived 'entity'. Perhaps this is all part of my own illusory effort after meaning and wish to simplify complex matters.

    I think you advocate the approach to start from symptoms and not syndromes, which may be false entities. This is eminently sensible approach, and an approach that might give a better basis of what to consider an ‘entity’.

    It is not easy to see what can replace the Platonic ideals. No wonder they have lasted so well.

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    1. Thanks for the very kind comment, Uta. And thanks most of all for owning up as an essentialist!!

      I know exactly what you mean about a 30 second diagnosis - I have that experience myself sometimes. But I guess the point is that I can also look at a rabbit and in less than a second identify it as a rabbit. So speed of identification isn't itself evidence for an essence.

      I think there's a really interesting study to be done on people's concepts and identification of autism. Modern (exemplar or prototype) theories of categorisation assume that you classify a new object based on comparison to members of the same category you've previously experienced. My guess is that variation in experience of different kinds of autism accounts for a lot of the variation in diagnostic practices between clinicians.

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  3. Great post Jon. From a parent perspective, whenever I find myself talking with others about how our children's various autisms manifest I find it fascinating to note the differences and similarities. This is of particular interest to me in terms of treatment/therapy options, and the dreaded "recommended hours of intervention" argument I often involve myself in. Or the dietary theories, which resonate with some and not so much for parents like myself whose child has no GI troubles. Where I used to find myself generally intolerant of parents who took alternative paths to my own in the treatment of their child I now understand that the autism they are talking about and living with is not the same as the one I am. This understanding has helped me to appreciate the width and depth of the autism spectrum. And although I'll always argue for evidence based interventions, as you raise in the above post, the questions remains, how do we undertake research that shows what type and intensity level of intervention works best for which type of autism?

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    1. Absolutely. I had a great discussion with my mate Giacomo Vivanti at the BioAutism conference earlier this year (see post from Feb). He was trying to predict which kids showed the greatest gains in function following intervention based on their pre-intervention characteristics.

      At present, most trials compare a particular intervention to "treatment as usual", which means basically letting the parents fend for themselves. A better option would be to have an RCT where kids were randomly assigned to different intervention programs. Then, rather than (or as well as) seeing which intervention was better on average, the researchers could take a more individual approach and develop criteria for optimally assigning future kids to different interventions.

      Disclaimer - I have absolutely no knowledge or experience of intervention research!!

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  4. Brilliant post, and beautifully written.

    The comment by "Me" above, does a great job of expressing my own experiences too; a growing appreciation over the years of the diversities of autism (not just in particular diagnostic grouping).

    I'm glad you got to experience so much of NZ's beauty while you were here, loved the photos :)

    (Comment by Autism & Oughtisms; your comment section seems to think I'm "anonymous" today)

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    1. Glad you like! New Zealand is indeed beautiful. Definitely coming back. Maybe South Island next time.

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  5. So, Jon... do you think that the better approach is to home in on a specific manifestation/behavior/phenotype regardless of label and just try to focus on what, specifically, might lead to that? If so, that fits with what I've viewed as an "addressing the gaps" model of approaching behavioral ameliorations, as opposed to wholesale "addressing the label."

    Like this post.

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    1. Definitely a better approach, although we should still be conscious of the possibility that similar manifestations might arise for different reasons.

      And "addressing the gaps" makes a lot of sense (assuming you're allowing for different individuals to have different gaps).

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  6. "Ultimately, “autism” is a label for a set of behaviours. By always beginning with autism and working backwards, we have invested too much significance in the label itself."

    I agree. I believe that the DSM and other literature contribute to a tendency to take labels far too literally. (Words like "symptom" contribute to this and unnecessarily pathologize differences. Why not "characteristic" or "trait?")

    This is a hard thing to talk about without appearing to say "autism is not real." Is autism a real "thing?" It depends what you mean by the question. To me the adjective "autistic" makes sense. There are ways of perceiving and being and interacting that in combination can logically be defined as "autistic." "Autism" on the other hand seems more and more to me like a box into which people with those behaviors are sorted. Because humans like categorizing and classifying, whether autistic or not.

    Thanks for writing this and directing my attention to it.

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    1. Thanks Bev. I very much like your argument about using "autistic" as an adjective rather than "autism" as a noun, although I'm still not convinced it gets us further scientifically. I think we have different objectives here, which is fine!

      I have to confess that I still do sometimes use pathologizing terminology. For example, "symptoms" is quite helpful in terms of differentiating between specific behaviours of some autistic people with autism, versus the idea of autism as a unitary syndrome. "Traits" is less pathologizing but means different things to different people - and risks underplaying the difficulties faced by many people with autism. I think there's always a tension between using words that are "non-pathologizing" and words that are understandable by the target audience. That's not to say that I/we can't do better!

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  7. Beautiful post Jon.

    Although I think Plato might be responsible to an extent (especially for those who studied classical thinking) I think Bev is right, it's the way we categorize that's at the root of this. Take two cognitive biases; the tendency to focus on prototypical features, and the primacy/recency effect (difficulty flipping from initial cognitive models to later ones) and you have an explanation for our preoccupation with 'essences' - and our difficulty with paradigm shifts.

    See, for example, Eleanor Rosch on 'natural categories' and Wikipedia entry on serial position effect http://en.wikipedia.org/wiki/Serial_position_effect

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    1. Thanks Sue. As you'll see from my response to Uta, I've been thinking along similar lines. It would be really interesting to study autism researchers and clinicians as a target population themselves!!

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  8. You've hit the nail on the head Jon. We have to start focusing on individual phenotypes and stop looking just at group averages, especially when the criteria of whom we lump together into a "group" are so superficial (and when we know that the group is really heterogeneous). Focus on symptoms rather than labels, both in research and treatment may be the way forward.

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    1. Thanks Kevin. Your talk at BNA last year (and Michael Owen's in the same session) were real eye-openers for me.

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  9. Of course, if autism wasn't a name brand and industry, none of you could get funding for research. Swings and roundabouts.

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  10. Touche!

    You're right, though. It's much easier to get funding and high impact publications for essentialist autism research.

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    1. And this is true IN SPADES for essentialist dyslexia research.

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  11. Lovely post.

    It seems to me that what's said in this post applies not only to autism, but also to other developmental disorders such as dyslexia or specific language impairment. Essentialism is also rampant here. One often still sees, for example, such claims as "The core of developmental dyslexia is phonological impairment", despite the very clear evidence that dyslexia is at least as heterogeneous as autism (so its specific language impairment).

    One could translate Jon's post by replacing "autism" with "dyslexia" throughout, and then show that the same points apply: for example, just as Pelphrey et al. offer the view that there is a single neural abnormality underlying autism, so many have argued that there's a single neural abnormality underlying dyslexia. But neither claim can be correct because both claims ignore the well-documented cognitive heterogeneity of each condition. Note the weasel-word "core": "core disruptions in social information processing" (Pelphrey et al) means "we know there are other disruptions, but we are not going to bother about them" - i.e "we know there is heterogeneity, but we are going to ignore this"

    Bottom line: Jon's points hold not only in the scientific study of autism: I believe they hold for the scientific study of developmental disorders of cognition in general, and that this is impeding scientific progress in this general field. The heterogeneity can be dealt with scientifically: but first we must overcome the essentialism and acknowledge the heterogeneity, in relation to all kinds of developmental disorders of cognition, not just autism.

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    1. Thanks Max. Funnily enough I had exactly the same conversation with Anne Castles yesterday!

      I think you're right to separate out the essentialism issue from the heterogeneity. In my research and on this blog I've been focusing a lot on heterogeneity within autism, but I think that's only part of a bigger picture, which involves looking across neurodevelopmental disorders.

      On the dyslexia theme, I really liked Frank Ramus's paper a few years ago (TiCS, 2004) where he was talking about genetic risk factors for cortical anomalies, but the precise consequences and hence the child's diagnosis would depend on where the cortical anomalies actually occurred.

      In the autism field, there is more interest at present in connectivity, but we can make a similar argument - genetic risk for dysconnection that manifests differently (and results in different diagnoses) depending on where (and perhaps when developmentally) the dysconnection occurs.

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    2. Following on the dyslexia comment, I think the idea of the phenotype emerging from the genotype in a probabilistic rather than deterministic sense is spot on. A mutation affecting a particular neurodevelopmental process will often not disrupt it completely, but degrade its robustness so that it sometimes works alright but other times does not. If the process is repeated in many sites across the brain, then you can get phenotypic effects emerging in different brain areas in different carriers of that mutation, possibly giving rise to quite different manifestations.

      This sort of effect may be why specific mutations can be associated with very diverse disorders (e.g., autism, schizophrenia, epilepsy, Tourette's syndrome are all associated with mutations in CNTNAP2 gene).

      It can also lead to the situation where a predisposition to a disease or condition in general may be inherited, but the precise form that emerges is more random, depending on which brain areas are more affected. We have observed this for synaesthesia, where very different forms co-occur in families (even twins; http://www.ncbi.nlm.nih.gov/pubmed?term=17586484%20). It is also seen for epilepsy, where different brain areas are involved between twins (http://www.ncbi.nlm.nih.gov/pubmed?term=21885256).

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    3. Thanks Kevin.

      The CNTNAP2 story is seriously interesting. I blogged about it a while back but I think that's already out of date.

      http://crackingtheenigma.blogspot.com.au/2010/11/genes-for-autism-or-genes-for.html

      Dan Geschwind has a recent review, which I'm about to read:

      http://www.ncbi.nlm.nih.gov/pubmed/22365836

      As for co-occurence in families, I think that's the big puzzle. If it were the case that there were distinct behavioural subtypes of autism that were linked to corresponding aetiologies, then we'd expect people from the same family to have the same subtype of autism phenotypically. But that's manifestly not the case. You'll get one kid who has classic autism, one with Asperger's, and maybe another with something else entirely (ADHD or DCD). This doesn't fit with a simple subtypes model, and it doesn't fit with an "essentialist" account either, unless the claim is that ADHD is essentially the same as ASD. So I think the only feasible explanation is something along the lines you've described.

      The good thing about paradoxes is that they tell you where your theory is wrong and where you should really start poking around. So looking at variations within families is probably the way to go.

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    4. There is genetic heterogeneity, and no doubt neural hetereogeneity. But those are uninterpretable unless we first get a clear description of the cognitive heterogeneity. All of this is true not only of autism and dyslexia and SLI, but also of Williams Syndrome and developmental prosopagnosia; so quite possibly true of all developmental disorders of cognition.

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  12. Your post is really interesting, and I want to thank you for the work you're doing on your blog, I enjoy it because you always manage to offer perspective. I have always been sure that philosophy can bring insights and help us think.
    I am also amused by your inability to stop thinking about work, and thus your ability to use any situation to build reflexions about autism !

    I hope you will not take offense of my perhaps naive comment, but here are some thoughts I came up with.

    I am very interested because I am under the impression that, confronted to the diversity of people with autism, and the aporia created by statistical and behavioural diagnosis, scientists can now suggest to focus more on individual "phenotypes".

    Plato would describe two worlds : the worlds of things, and the world of "ideas". These ideas are the ideal and essential models of things, and things are thus determined by ideas.

    Sartre's existentialism, on the contrary, says that "existence precedes essence", which means that one individual is not determined by an essence, that things are first, and men exist before they can think the "idea" of "man" and then give birth to essential concepts (it is difficult to talk about all this in english, forgive me !).
    This is why everybody know what "man" is, but this doesn't mean that "man" existed before all men, or that there is an "abolute" man above all.

    Where Plato is determinist, Sartre states that one is defined by his actions and his existence in the world, and that choice is always possible.
    Sartre had a huge influence on ways of thinking in France.

    In France a lot of people working in the field of autism have not abandonned the psychodynamic point of view (I would like to emphasize that most of smart people were horrified by the people interviewed in "the wall", and I don't know anyone working like that, but this is a whole other question) but have made it evolve to meet scientific discoveries and observation facts.
    In France, this point of view, nourished by philosophical background such as Sartre, Merleau-Ponty... is the one allowing to focus on singularities.
    We need science to understand the "essential" mechanisms underlying autisms, we also need a humanistic method to understand the individual's way of being.

    So, it is very interesting for a french psychologist like me to read that scientists feel they may need to address more the individual differences. It really makes sense to me.
    I hope this was not too boring. I just wanted to point at the bridges that can link two paradigms that are often considered as opposed.

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  13. To understand how essentialistic is our way of thought we must go to the basics.

    We have a tendency to accept terms as "autism" as valid entities and use them to explain every event we face. They become recurrent, and yes, essential to our reasoning.

    When we talk about autism or any other mental pathology, we must not forget that we are not using signs of a disease (as objective features).

    Somehow we decided that certain responses deserve a name. To make it "easy" we establish arbitrary boundaries like "take 3 out of five".

    Amazingly, mental pathologies that we take for granted are decided by the votes of an elite. That's how homosexuality was considered for a long while a disorder until social pressure got the vote from the psychiatrist establishment on the contrary.

    So, psychiatry and his mental illnesses or diseases are established upon votation of a few. Quite unscientific I'd say.

    I would suggest that before we talk about autism in terms of a complex and heterogeneous disorder, we must establish what a disorder is (mental disorder in this case, very important) since I do not see, so far, anything other than a bunch of responses that we decide must have a label called autism and that label is, therefore, a disorder.

    From there the label or expressions like "people with autism" become the causal elements that explain behavior. What a twist: we observe behaviors, give them a name and then we use that name to explain those behaviors.
    Evidently terms like "autism" "PDD" "schizophrenia" are all labels and as such they cannot never be explanations of anything.

    Taking for granted "the disorder" then we commit a second mistake. Like everything in life, we think a disorder must occupy a place in the universe, must have a location. Therefore, we look in the brain.

    We are blind to the possibility of phenomena not having a location or the idea that behavior can be a type of relationship with necessary elements such a body or a brain, but not sufficient to explain behavior.

    We are also blind to the idea that perhaps mental patologies do not exist other than in our language.

    Yes, I agree that "we have invested too much significance in the label itself". Not only that, the most popular members on the autism world tend to be the ones searching for the rarest or oddest behaviors in order to accentuate the label and the difference of "autistic people" in respect to us, "the normal people.

    If I properly recall, it was Mayr himself who considered that the mixture of the same terminology for the different disciplines was a recipe for disaster.
    We have put together too many disciplines, all at the same level, like sciences without boundaries and their own characteristics and features.

    Just another mistake to add to the puzzle. Perhaps that's why it has that symbol.

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  14. Sometimes a rabbit is just a rabbit.

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  15. Lovely post. Agree that Richard Lenski’s work is great (my field, sort of).
    Paul Rainey in New Zealand is also worth looking up. Two weeks ago I met Bruce Levin, Lenski’s former collaborator and PhD supervisor, and founder of the E coli liberation front (www.eclf.net) [1]. He pointed out a similar problem with essentialism in bacteriology: bacteria tend to be described as either antibiotic sensitive or resistant. The reality, of course, is that there is a whole range of levels of resistance, as well as different patterns of expression of resistance. All that variation makes a difference to an infected patient. If you think only resistant/sensitive you miss half the story.

    Could it be language itself that forces us into this trap? It’s interesting just how many scientific breakthroughs come from people reasoning not with words, or even mathematics, but with pictures (Darwin’s trees, Einstein’s clocks on trains etc). Could language impairments even lead to better scientists? Einstein, Teller and Richard Feynman all had significant language delays. The current head of the Royal Society, Paul Nurse, struggled to get a place at university because he continually failed his French ‘O’ Level. Some of the best scientists I know are dyslexic. Has anyone ever looked systematically to see if there is really a pattern here? Are those who reason using pictures more than words more likely to make large conceptual leaps?

    I guess the autistic spectrum metaphor is an improvement on the autistic/non-autistic dichotomy (1 dimension instead of 0, a line instead of a dot), but maybe we need to think in more dimensions than that. Statistical clustering approaches could help here, though researchers might be resistant to such approaches because with the same number of patients it’s much harder to show so-called “statistically significant” findings if you have 3 or more groups instead of two. Without such statistical significance it can be hard to publish papers. But that’s a whole other worm can.

    Worth also remembering, in some cases the essentialist position does turn out to be justified. Williams Syndrome (WS), for example, has a single well-defined cause. Intuitively I would have thought less variable than autism (or perhaps as variable, but less likely to form into distinct clusters). It would be interesting to compare the results of cluster analyses of, say, behaviours or brain scans or face measurements or whatever of kids with WS and kids diagnosed with autism. Hypothesis would be that WS cluster into one group, while those with Autism would cluster into several.

    [1] While discussing animal models for bacterial infections he also made the observation: “We need better models than the mouse. Something bigger. Like a pig. Or a Republican.” I guess the same could be said for autism research.

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  16. Hi Jon

    Sitting thousands of miles away I am back in MACCS. Great post as always. Names of Max and Anne bring me close to home in Sydney...

    On to the next!
    Cheers
    Usha

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  17. Nice name for a campervan! :) Good thing that trip offered you much time to read that wonderful book. Impressive analogy on autism too. Thank you.

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  18. Not sure this is helpful but Karen Barad and others write about the origins of representationalism, which, according to Hacking, can be traced back to Democrtius: According to Hacking’s anthropological philosophy, representations were unproblematic before Democritus: “The word ‘real’ first meant just unqualified likeness” (1983, 142). With Democritus’s atomic theory emerges the possibility of a gap between representations and represented.-- “appearance” makes its first appearance. (p. 48 of Barad, K. M. (2007). Meeting the universe halfway : quantum physics and the entanglement of matter and meaning. Durham: Duke University Press. And to cut a very long argument short, you get to think not about categories or boxes in which to put things but the practices that enact or do the boxes.

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  19. I think the essence of autism should not be sought at the level of phenotype but at an underlying global mechanism which pervades the brain and so affects different brain functions. You can see the idea in this image (http://pairal.net/im/levels.jpg) and its development in this article (http://pairal.net/asperger/HED-Cererols.pdf).
    Ramon Cererols (pairal.net) (rcererols@gmail.com)

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  20. But aren't chromosomes and regions of chromosomes also ideas? If you're going to argue against an essential rabbit-ness, and an essential autism-ness, why not argue against an essential chromosome-ness? What separates it from these other ideas?

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