A touch of the 'tism, Part III

On drugs

Photo by Marc-Olivier Jodoin on Unsplash

Autism Spectrum Disorder

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is one of those conditions that you have to catch early and address correctly if you want a boy to have a fighting chance. I don’t care if you think vaccines caused it or not (I don’t, having read the cooked studies that cost Andrew Wakefield his license to practice medicine), because regardless of the reason, if your kid has ASD, you have to address it.

It can be addressed, too. Boys on the spectrum are clumsy and socially awkward, but the clumsiness begins to disappear with puberty, and socializing them correctly deals with the awkwardness. If you’re conscientious about getting the right kind of behavioral intervention—which may involve early behavioral training with a therapist, but should also include martial arts lessons, apprenticeships, and other opportunities to be appropriately socialized by positive examples of masculinity—your sons have an excellent chance of ending up happy and fulfilled, with loving romantic relationships, rich social lives, and good jobs.

Where society has gone wrong with autistic boys is in treating autism, which can present in children as a temper control problem or a moral deficiency, the same way it does a mood disorder or a personality disorder. We aren’t bipolar, and we’re capable of empathy. Autism is a difference in anatomy; our brains are structurally distinct from those of neurotypical people. The way in which areas in our brain connect is different, as well, which may be the cause of both our social developmental delays and our hyperfocus. As such, treating us with psychiatric drugs like neuroleptics or SSRIs doesn’t deal with the underlying issue, and is in fact counterproductive; the only people who benefit from administering blunt instruments like psych drugs to autists are the administrators of the schools autistic kids attend (who don’t want to deal with the behavioral requirements of autistic boys) and the psychiatrists who prescribe the drugs.

Psychiatric medication as employed today is pernicious, generally speaking. The promise of scientifically treating a “chemical imbalance in the brain” with carefully targeted drugs, which was based on a hypothesis put forth in the 1950s and 60s, was primarily a marketing ploy by pharmaceutical companies. Most of them don’t work the way they’re advertised. Antipsychotics like Abilify, for example, which are routinely prescribed as “antidepressant adjuncts,” act on the same receptors as cocaine. Class-action lawsuits in the US, Canada, and New Zealand allege a direct cause-and-effect relationship between Abilify and compulsive gambling, and the drug now carries an FDA “black box” warning label as a result. Benzodiazepine tranquilizers, “mother’s little helper,” increase the risk of dementia and cause permanent brain damage, as well as disinhibition and aggression that induces criminal behavior. SSRIs and the MAOIs and tricyclic antidepressants that preceded them were never intended for long-term use. They were a band-aid for grieving people that would keep them going for long enough to get what they needed to do done. The brain is highly neuroplastic, and it adapts to the boost of serotonin after about six months, leaving only the side effects of the drug, which are much more severe than are commonly understood, including sleep disorders, a “manic switch” (meaning they trigger mania analogous to that found in bipolar disorder), and sexual dysfunction in fully 75% of patients.

These are among the drugs they give autistic kids to make them compliant in school. Never mind that these drugs, which are basically terrible and only get FDA approval after the goalposts for efficacy are moved repeatedly because they don’t do what they’re supposed to do, do this shit to neurotypical adults, they are being given to children whose brains aren’t even built the same way.

I’m going to step back before I start writing entire paragraphs in italics, because the subject makes me want to throw my computer across the room. Let’s talk about SSRIs in particular.

There are a couple different families of antidepressant, each of which prevent the reuptake of a different neurotransmitter or combination of neurotransmitters

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. Buproprion (sold as Wellbutrin and Zyban), for example, prevents the reuptake of dopamine and norepinepherine, reward chemicals most notably released when you have sex or exercise. But SSRIs like Prozac and Zoloft selectively prevent the brain from reabsorbing free serotonin, the same huggy, blissed-out social reward chemical that floods your brain when you do MDMA. Serotonin in the autistic brain doesn’t work the same way as it does in the neurotypical brain; autists tend to have chronically low levels of serotonin, and the reward mechanism by which children learn social skills is serotonin-dependent. Giving autistic people SSRIs certainly seems to help with some repetitive behaviors and social anxiety.

My assessment of autism and social skills, which comes from many years spent focusing on learning every aspect I could of my passion, The Dance, is that the reason autists don’t get as much out of getting social skills right is that we don’t get the same neurochemical rewards for learning them. The system associated with puzzle-solving or physical activity that provides the neurochemical reward of dopamine works at least as well as that of neurotypical people, but since our serotonin system doesn’t work the same, and learning social skills does not provide the immediate rush of dopamine we associate with reward, we undervalue them. SSRIs, which increase serum serotonin, seem at first glance to be a magic bullet. But SSRIs have terrible side effects. Who wants to learn to navigate a romantic relationship with a woman if you can’t orgasm when you have sex with her? And since SSRIs reduce sexual desire to begin with (not to mention causing weight gain, which makes you both less attractive and more depressed), the motivation to get into a relationship in the first place is absent. When you combine those facts with the rate at which SSRIs “poop out,” which is caused by the brain adapting to the boost in serotonin, and which requires constant adjustment of doses and jumping from drug to drug, you get a distracting, unhelpful medicalization of a condition that wasn’t necessarily a problem in the first place. There are better solutions.

If you want autistic boys to learn social skills, you have to engage a different reward pathway, one that doesn’t depend on the release of serotonin. Our dopamine system works fine, so teaching social skills to autistic kids in the course of performing tasks that give them a sense of dopamine-hit-worthy accomplishment and at the same time teach them to move more gracefully and/or teach them a practical skill is a clear winner. Brazillian Jiujitsu and the kind of work you learn in the trades are obvious examples; the first combines unambiguous “you learned to do it right or you didn’t” accomplishment-based dopamine dumps, contact with positive male role models, physical competence, and social group bonding, and the second does those things and provides a tangible financial reward that can support a family. The puzzle-solving of pickup artistry is another workaround, but it’s considered socially undesirable because it rewards manipulative behavior. If instead it were promoted using the metaphor of dance, which is cooperative, instead of hacking, which is coercive, that might not be the case.

(As I write this, I’m imagining a Budweiser-esque Super Bowl commercial for a school of pickup artistry for autistic men in which a pack of young nerds, jacked from practicing BJJ, their pockets flush with cash from their good trade jobs, roll up to the town square. There’s a tense pause where no one’s quite sure what these fit young wolves are going to do, and then they all suddenly engage in stylized, dramatic demonstrations of their social prowess, to the rapt admiration of the town’s women. I’m probably more entertained by the idea than I should be.)

I think of autists as a very slightly different species than neurotypicals—akin to the difference between a wolf and a large dog, perhaps, per Temple Grandin’s declaration that we’re “between human and animal.” You socialize wolves to humans differently than you do dogs, because the motivation inherent to wolves does not include pleasing humans; that’s something we bred into dogs. But they (and we) can be socialized to coexist with humans, and while the result of socializing wolves to coexist with humans is dogs

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, the result of socializing autists to coexist with neurotypicals is the advances in STEM (and the arts!) that accompany the introduction of the autistic perspective, which is completely different than the neurotypical approach to the problem-solving process. As Linus Torvalds said, “Given enough eyeballs, all bugs are shallow.” Having different perspectives on problems is inherently good.

I realize this is an autistic thing to say about human beings, but we’re useful. We think about things in a way unlike most people, which has historically produced significant advances in the standard of living across the board. But if you want an uptick in Isaac Newtons, Henry Cavendishes, and Albert Einsteins (not to mention more Hans Christian Andersons, Tim Burtons, and Dan Ackroyds), making it possible for us to succeed is going to require rethinking the way we are treated when we’re young. And that starts with the way society thinks about masculinity.

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In Part IV: More on SSRIs, the elusive autistic feeemale, and the connection between psych drugs, politics, and masculinity. Part IV will be the last post in this series; I’ll be going back to rhetoric for a bit after I wrap it up, so post links to shitty/insane/infuriating woke arguments you want me to deconstruct in the comments section so I have something to write about!

1. ASD is what I’m referring to when I say “autistic,” or “autist.” Nonverbal autists and their parents have an incredibly tough row to hoe, and while I’m totally sympathetic, their struggles are outside the scope of this article.

2. The model in this section is a necessarily simplified take on how neurotransmitters that affect mood work. Serotonin is also released when you exercise, for example, and dopamine is a reward chemical released in many situations that don’t involve physical activity. But the dopamine dump you get when you have sex or work out is obvious, and serotonin’s role in social interaction is well-known, if not necessarily well-understood.

3. I realize I’m mixing my metaphors here. Work with me.