Friday, April 21, 2017

The Baby and the Bathwater: Concepts That Are Flawed But Still Useful

I think there's an important distinction between "this concept is being used in a flawed and damaging way" and "this concept is inherently useless and damaging". But too often, I see people confusing the two, and assuming that if there are valid criticisms of a concept, it's an entirely useless concept that can only be harmful.

Here are some concepts I think still have some use, despite their flaws.

Mental Age

Mental age is the idea that if you compare an atypically developing child's scores on a cognitive test to the results of NT children of varying ages, very often their pattern of functioning will be similar to that of most NT children at a particular age. This age at which responses are similar to the atypical child's responses is termed that atypical person's "mental age".

This has traditionally been taken to mean that atypical children should be like NT children with the same mental age in all sorts of ways, including ways not actually assessed by the test used. For example, a 15 year old with a cognitive mental age of 5 years is assumed to also have the emotional maturity of a 5 year old, the interests of a 5 year old, the academic abilities of a 5 year old and the level of independence of a 5 year old. This can result in unfair restrictions on this person, missed opportunities to do things a 5 year old wouldn't be ready to do, and generally treating this person like a small child when he or she would rather be treated like a teenager.

For an added wrinkle, some atypical people have skills that are not standard for any age of NT. For example, an autistic child who communicates through complex echolalic but mostly situationally appropriate sentences has a language profile that is not typical of NT children at any age, so assigning a mental age to that child's language abilities is fairly arbitrary.

And lastly, not all NT kids are actually taught to their full potential. For example, there is evidence that under the right circumstances, NT 1 year olds can actually be toilet-trained. In addition, no real effort is usually made to teach reading to children under 6 years old, but some children have learned to read much younger with direct instruction. This means that even if most NT kids at the same 'mental age' aren't being taught a skill yet, direct teaching might enable a delayed child to master that skill.

But despite all this, I think mental age is still a useful concept, provided you a) confirm that they are actually showing a normal pattern of development at a different rate, and b) remember that the mental age given by a test only applies to the skills assessed by test.

For example, on most cognitive tests, adult non-human great apes score similarly to human preschoolers. Social cognition is similar to a typical human 3 year old, language is more like a 2 year old (in language-trained apes), while folk physics understanding is more at around a 5-6 year level. (Working memory, meanwhile, is better than most human adults.)

This data pretty reliably predicts what cognitive toolkit a typical non-human great ape has for solving problems.  For example, when it comes to social problems (eg "how do I keep that guy who's bigger and stronger than me from taking away this snack I just found?" or "how do I do this thing I want to do and not get in trouble for it?") non-human apes solve these problems about as skillfully as 3 year old humans do. For example Koko, a sign-language trained gorilla, when asked who ripped the sink off the wall, blamed her cat All Ball - about as plausible a lie as the ones many 3 year old humans make.

And yet, if you left a group of 2-6 year old children in a rainforest by themselves - even if they'd grown up in that forest from birth - I doubt they'd survive very well. This is a challenge that suitably prepared non-human apes can easily manage. Indeed, some non-human apes grow to be very wise and experienced leaders in their societies, guiding the younger generations.

If you take mental age as 'the age they really are inside', you're doing it wrong. But if you take mental age as 'they will probably be able to do X task in skill area Y because typical kids with the same mental age in skill Y can', then it's a pretty useful concept.

IQ Score

This is a closely related concept to mental age. In fact, originally IQ scores were derived by dividing 100 by the person's actual age and then multiplying by their mental age. Now, they're usually determined more by the percentage of same-age peers who score higher or lower, but the link still applies, and IQ can be misused in the same way that mental age is.

However, there are also some misuses that are more directly associated with IQ. Since IQ is always determined by standardized testing (while mental age can be determined in lots of different ways), many of the criticisms of IQ relate to problems with standardized testing.

The biggest problem is underestimating performance. If a person fails to answer a question on an IQ test correctly, did they really not understand the concept? Or did something else interfere? If they didn't understand the instructions, weren't physically capable of responding correctly, interpreted the question in an unusual way or just plain decided not to answer correctly, their IQ score will be an underestimate of their true cognitive ability. This is the main reason why ABA can increase IQ in autistic children - it doesn't make them smarter, but it does make them more compliant, better at understanding commands, and teaches them what kind of behavior is expected in a testing situation. (Basically discrete trial training is like non-stop testing with the correct answers being given to the child until the child learns them.) In other words, they become more 'testable', and so their IQ goes up.

Another criticism of IQ comes from the myth that IQ should predict adult performance. Many people express skepticism about the idea that a person with a genius-level IQ could be working at McDonalds instead of revolutionizing some field of study. But IQ was never intended as a fortune telling device, and there's a lot that determines success apart from IQ - socioeconomic status, disability, motivation, resilience, educational opportunities, and pure luck and timing. Einstein wasn't just smart. He had supportive parents, he was fascinated by physics and mathematics, he had enough mental resilience to withstand a bad school experience, and he entered the field at a time when the conditions were ripe for the discovery of relativity.

There are people who are every bit as smart as Einstein, but these other factors haven't come together as much. Torey Hayden's books One Child and Tiger's Child feature a girl with an IQ of 182, which is higher than the common estimate of 160 for Einstein. But at the age of 6, she was in a special education class as a last resort before going into a state institution. Why? Because she was from a poor, neglectful and severely abusive home (she was hospitalized once because her uncle stuck a knife in her vagina), and had severe emotional problems (she poked out the eyes of the classroom fish). Given her struggles, the fact that, as an adult, she was able to live independently, stay out of trouble and be employed was remarkable. Could she have revolutionized a scientific field? Maybe, if she'd had the opportunity. But it's not really surprising that she didn't, given how much the tables were stacked against her.

Friday, April 14, 2017

Does Your Identity Reinforce The Gender Binary?

An ongoing debate seems to be raging about whether people who are attracted to multiple genders should identify as bisexual or pansexual. The argument is that bisexual, because it has the Latin prefix for two, means someone attracted to two genders, and therefore people who identify as bisexual and feel attraction for nonbinary people are invalidating the nonbinary people's identities. Many bisexual people have responded saying that the 'bi' in bisexual refers to being both heterosexual (attracted to people with gender(s) different from your own) and homosexual (attracted to the same gender).

First, I'd like to acknowledge that I'm weighing in as an outsider. As a cisgender aromantic asexual, none of the labels I'm discussing here relate to me personally. The closest I come to identifying as any of these labels is ticking 'bisexual' in surveys that provide only three sexuality options, because my own attraction is equally nonexistent for all genders.

But it's interesting to me that I don't see the same furor over lesbian-identified women dating trans men. (Or the reverse, though I don't see that very often at all.) While some women choose to change their identification because of the realisation that they're also attracted to trans men, others don't, and it seems to be recognized as a personal choice and not necessarily a political one.

And I agree with that stance, by the way. After all, there are women who identify as lesbians despite experiencing some attraction to cis men, too. A woman who is Kinsey 5 may feel that lesbian is the best descriptor for her identity, despite her potential to be attracted to men. Or a woman who is biromantic homosexual or bisexual homoromantic may identify as lesbian because she only feels both attraction types together in relationships with other women, or because her attractions counted together result in a significant preference for women. If a woman can have attraction for cis men and still be lesbian, certainly a woman can have attraction to trans men and still be lesbian.

Personally, I don't think you can judge from someone's label, or their label plus their romantic and sexual choices, whether they support binarism or transphobia. It's the reasoning behind their label choice, and their overall behavior and attitudes towards transgender and nonbinary people, which really determine whether they're binarist and/or transphobic.

For example, there was a straight man I heard of who dated a trans woman, but insisted that she had to allow him to have casual sex with cis women in order to meet his sexual 'needs' because he was 'not gay' and therefore not satisfied by sex with his non-op partner. His labelling himself straight while dating a trans woman superficially sounds accepting, but the fact that he insisted that she couldn't satisfy him sexually because he wasn't attracted to men belies his apparent acceptance of her identity, and suggests that he really did see her as a man on some level.

In contrast, my brother has a male friend who started dating someone he believed was female. His partner then came out first as FtM, and then they came out again as nonbinary. In response, he shifted his own identity from straight to bisexual. Although I haven't asked him about his feelings in depth, from my understanding, he has never been attracted to cis men. His identity as bisexual appears to be based on his potential to be attracted to cis women and transgender/nonbinary individuals, in which case he clearly demonstrates a willingness to acknowledge trans and nonbinary identities using a label commonly stereotyped as binarist.

I have also heard of bisexual-identified people who say "I have never knowingly met a nonbinary person, so how can I tell if I'm attracted to them?" Exposure to cis males and cis females is pretty much universal, so a questioning person can readily collect data on how their sexuality reacts to these people. Transgender and/or nonbinary people are a lot harder to find, and may not be out when you encounter them.

There are also nonbinary and transgender people who identify as bisexual. And there are nonbinary and/or transgender AFAB who identify as lesbians, and AMAB who identify as gay, despite those labels implying a gender they don't identify with. (This seems especially likely for nonbinary people who exist in the spectrum between cis and gender neutral, such as AFAB demigirls, but there are FtMs who consider themselves lesbians despite identifying completely as male.)

In conclusion, don't judge from the label they choose. Judge from their reasoning and attitudes around actual transgender/nonbinary people. And in that respect, it's important to remember that bi/pan/multisexual people, on average, have a better track record for accepting transgender and nonbinary people than gays and lesbians do.

Friday, April 07, 2017

Why Self-Diagnosis is Important - A Response to kellyann-graceful-warrior

(Note: I don't actually know which pronouns either of the people I'm discussing here actually use. I'm guessing both (Purr)ple (L)ace and kellyann-graceful-warrior use she/her pronouns, but if I've guessed wrong, just let me know and I'll edit this.)

I was browsing (Purr)ple (L)ace recently, and came across this thread. (Note: I made the mistake of thinking she agreed with it, because I didn't realize that she responded in her tags rather than in text. She doesn't.)

But in any case, I feel a strong desire to respond to this, so I will.

Kellyann's first argument seems to be that self-diagnosis is prone to error. Which is true. But a) so are official diagnoses, b) misindentifying yourself doesn't mean that you shouldn't have been looking for answers at all (imagine if we took the same attitude to gender and sexual orientation?), and c) just because you've misidentified doesn't mean you can't find stuff that helps you aimed at people with that diagnosis. I'm autistic, not ADHD (seriously, I've had dozens of psychologists say I'm not ADHD, because my school really really wanted me to get that diagnosis). But I've found a pile of ADHD advice that has helped me too, because ADHD and autism overlap.

Her next argument is that badly behaved people who use self-diagnoses as excuses give actually diagnosed people a bad name. To which I point out that actually diagnosed people can behave badly and use their diagnoses as excuses too. And that "you're giving us a bad name" places the blame on the wrong target - the real problem lies with people who assume that one member of [insert minority X] must represent every single person belonging to that minority group. If someone goes "I met a really shitty person with BPD who used it to excuse abuse, ergo all BPDs are shitty abusers", that's pretty much the same thing as saying "I met a transphobic and homophobic asexual who slut-shamed and considered themselves superior, ergo all asexuals are transphobic homophobic sult-shamers who think they're superior". Essentially it doesn't even matter if the person they met was accurately identified or not - the problem lies with the person who stereotypes a whole group based on one person.

Secondly, she talks about how complicated it is for psychologists and psychiatrists to actually diagnose someone. As a psych major, I can tell you - it's really not as complicated as people think. It's nothing like physical medicine, because the vast majority of diagnoseable mental conditions aren't based on running tests or determining causes or anything other than just, yes, checking the person against a checklist. (Yes, there are a few diagnoses that are more complicated, such as MR, which requires an IQ test. But those are the minority.) The DSM is designed so that you can use it to diagnose someone and know you're using the same definition of that condition as someone else is using, even if you come from very different backgrounds (i.e. a psychologist who regularly does outpatient treatment should use the same diagnostic standards as a pediatrician whose only experience with mental health came from their mandatory psychiatry rotation during medical school). It doesn't always work as intended, but that's what it's for. And as such, it's really not that big of a stretch to consider an untrained but well-read person using the same criteria and coming up with a similar level of accuracy.

Next, she complains about people diagnosing things that shouldn't be possible or are very unlikely, such as mutually exclusive diagnoses, extremely rare ones, or conditions that have age restrictions.

First, she makes a factual error here. The only personality disorder with an age restriction is antisocial personality disorder, and that's because ASPD and conduct disorder are basically the exact same condition at different ages, and someone under 18 with the symptoms of ASPD should be diagnosed with CD instead. (ASPD also requires that you met CD criteria before you turned 18.) All other personality disorders can be diagnosed in teenagers according to DSM rules, although many clinicians refuse to do so out of fear of stigma or because they overextended the ASPD rules by mistake. I did a couple papers for one of my classes on teenage BPD recently, and I know for a fact that the research finds the exact same validity and stability for BPD criteria in teens as in adults. What little I've read suggests similar findings for other PDs, too, except for ASPD. (There's a major subgroup of CD individuals who have CD/ASPD symptoms only in their teens and early twenties and transition to completely different symptoms with age, which is one big reason why ASPD has an age restriction.) So, yes, teenagers can absolutely have personality disorders.

Secondly, not all mutual exclusions in the DSM actually are warranted. For example, up until DSM 5, ADHD couldn't be diagnosed in autistic people, because it was assumed that ADHD symptoms could be explained by autism. However, research showed that children who had both ADHD and autism symptoms were different from autistic kids without ADHD, in similar ways to how allistic ADHD kids differed from NTs, and that ADHD symptoms in autistic kids were helped by ADHD treatments just as much as in allistic kids. For example, stimulant meds do nothing to help autistic kids without ADHD, but were just as beneficial in autistic ADHD kids as in allistic ADHD kids. Based on those findings, the DSM 5 removed that restriction. Before this happened, I knew several autistic people with self-diagnosed ADHD, or ADHD diagnosed by clinicians who ignored that restriction, who were benefiting from knowing why they differed from non-ADHD autistic people. Similarly, I'd support ignoring the mutually exclusion rule for reactive attachment disorder and autism, because the research really doesn't support the idea that it's impossible to tell if someone has RAD when they're autistic. Even bipolar disorder and depression could potentially co-occur, judging from cases where a person with well-controlled BP continued to have depressive episodes and then responded well to having an antidepressant or CBT added to their existing mood-stabilizer. (Note: Clinicians should never give a BP person an antidepressant if they aren't already responding well to a mood stabilizer, because it can trigger manic episodes.) And as for the schizophrenia/schizoaffective/bipolar mess, that's mostly historical, and schizoaffective is basically just a fancy name for someone with both schizophrenia and bipolar disorder.

Thirdly, regarding rare conditions (like early-onset schizophrenia), rare doesn't mean nonexistent. There's certainly at least some people with early-onset schizophrenia online, and that random Tumblr user could be among them. You really can't tell.

And fourthly, controversial conditions are still diagnosed. Maybe some of them should be scrapped (personally I don't think histrionic PD is meaningfully distinct from BPD and narcissistic PD, for example), but that doesn't mean that people can't find something useful from identifying themselves in those criteria.

Next, she points out that you can learn to understand yourself, help yourself, and advocate for yourself without self-diagnosing. Which is true. I certainly have benefited from recognizing that I have BPD traits and adopting strategies that people with BPD use, such as DBT, even though I don't actually meet the criteria for BPD. But labels, even self-applied labels, do have a purpose, for several reasons:

a) They remind you that you're not alone, and help you find people like you. If I didn't know that I'm autistic, I might still know that I can't handle loud noises, have trouble reading people, can't look after myself as well as most adults, and so forth. But how would I go about finding people like me? How would I input that mess of traits into a search engine? Having a single label that covers all that stuff is really useful.

b) They can be used to communicate to others. When I was a kid saying "I can't do that, I don't know why", no one listened. Now, when I say "I can't do that because I'm autistic", people listen. Not everyone, because ableism, but a whole lot more than they used to. I've had people literally shut up and apologize as soon as I invoked autism as an explanation for the thing they didn't like about me. Can this be misused? Sure. But it can also be used appropriately, and it can be very empowering and useful.

c) They can help you accept yourself. When I just "thought I might be autistic", there was always this doubt in the back of my mind, telling me "you're not autistic, you're just lazy/stupid/inconsiderate". Getting my official diagnosis silenced that voice, and self-diagnosis can do that too. Whatever lets you trip the line from uncertainty to certainty, that's a powerful cure for the Imposter Syndrome.

d) They can help you plan. Realizing I'm autistic was instrumental in realizing that me being able to live independently as an adult was not a given. I've heard horror stories from autistics with similar difficulties to me, who jumped into adult life without any idea that they wouldn't just figure it out on their own like NTs do. There are autistic people who have starved, who have ended up homeless, who've had homes so messy they were unsafe to live in, etc, all because they were expected to function as well in adaptive living as they do cognitively. If I hadn't heard those stories as a teenager, that could have been me. I could have jumped into independent living assuming I could do it, when I really can't, and ended up in dangerous circumstances as a result. Instead, because I know I'm autistic, I'm planning it out carefully, assessing my own abilities regularly, and working on safety nets so my first forays into independent living don't end in disaster. I'm also planning for the possibility that I might never live independently, and figuring out what I'll do when I outlive my parents.

Essentially, self-diagnosed labels can be useful for all the same reasons that gender and orientation labels are. So you can find people like you, communicate who you are to others, accept yourself, and plan for future possibilities that diverge from the normative path.

Next, she says it's unhealthy to self-diagnose. I'm not sure exactly why - this section seems to throw out a bunch of facts without really tying them together into a real argument, as far as I can tell. I can say that I don't really get what self-diagnosis has to do with denial, or why teenagers searching for identity means they can't figure out something real about themselves. (After all, many people correctly identify gender and orientation in their teens.)

Then, she returns to the "giving us a bad name" argument, which I've already responded to, and also claims that self-diagnosed people are spreading mockery. It's not entirely clear to me whether she's complaining about people mocking self-diagnosed people (which really isn't their fault - being mocked by someone else is never your fault) or claiming the self-diagnosed people themselves are mocking people who actually have that condition. The latter would be a bad thing, if it was actually that person's motivation, but I'm not convinced that it really applies to more than a tiny minority of self-diagnosed people. Just as people who claim to sexually identify as "attack helicopters" are a tiny minority among people who claim nonbinary identities, and shouldn't be taken as representative of actual nonbinary people, people who claim a self-diagnosis purely to mock people should also not be taken as representative of actual officially diagnosed or self-diagnosed people.

Lastly, she comments on arguments regarding access to diagnostic services by claiming that similar barriers have applied to her in the past. Which really doesn't negate that argument, any more than a rich person who grew up poor and thinks other poor people should do what they did negates the argument that poverty is a real problem that restricts people's opportunities. And while the resources she linked to do sound useful, they're not necessarily accessible to everyone - eg teenagers with unsupportive parents and no means of independent transport, people who live in rural areas or cities that lack those resources, people who need a kind of help that isn't what their local free clinics provide (for example a lot of free counseling centers only provide CBT, which doesn't work for everyone), people who get turned away or put on waiting lists, people who've been saddled with incompetent clinicians, and many others. Access to treatment is a tricky problem and it's not solved just by having a few free clinics.

And then there are people who don't want an official diagnosis. Maybe they risk facing stigma, or being barred access or having reduced access to something important to them. (For example, military service or adopting a child.) Maybe they don't want to see a clinician. Maybe they don't actually need help, or don't want to change what makes them different from others. Those can all be perfectly valid reasons not to seek a diagnosis, and none of those necessarily mean the person can't benefit from a self-diagnosis.

Saturday, April 01, 2017

Carnival of Aces Call For Submissions for April 2017

The April 2017 issue of the Carnival of Aces will be hosted here, and I'm seriously excited about it.

The topic is "Asexuality, Aromanticism and Parenthood".

As usual, you can interpret this in many ways. I want this to be an inclusive topic. I want parents, planning-to-be parents, not-sure-if-want-to-be parents and will-never-ever-be parents to all feel free to weigh in. You can weigh in if you're a romantic asexual, aroace, allo aro or anything in the grey areas.

If you already have an idea what to write, go ahead. If not, here are some thoughts.

If you are or want to be a parent:
  • Has or will being asexual and/or aromantic lead to a different family design than the standard 'two biological parents married to each other'?
  • Has it made trying to conceive more complicated? Has it made trying to adopt more complicated?
  • Have you come out to your children? If so, how did you have that conversation (or conversations).  If not, do you have any plans to?
  • Does being asexual and/or aromantic affect how you discuss or plan to discuss sexuality and relationships with your children?
  • Do you worry about society judging you for being an asexual and/or aromantic parent? Have you been judged negatively for it?
  • Did you know you were asexual and/or aromantic when you had children? Would it have changed your decisions if you had?
If you are not sure or are childfree by choice:
  • Is asexuality or aromanticism a factor in your decisions about parenthood?
  • Do you get a lot of pressure from others to have children, and if so, how do you deal with it?
  • Do you think wanting or not wanting grandchildren has or will affect your parents' reaction if/when you come out to them? Is it a factor in deciding whether or not you will come out?
  • Do you see society's expectations of parenthood as part of heteroamatonormativity, or a separate issue?
I look forward to seeing everyone's thoughts. Have fun!