This is a translation of an article published in the Swedish journal of psychology "PsykologTidningen", no 16 1996.

Reply to review

In the June-July, 1996, issue of Psykologtidningen (The Swedish Psychological Association Journal) Cecilia Hector reviews my book about growing up and living with an autistic disability, A Real Person. The review is long, and on the whole, Hector is very positive which probably will attract many readers to purchase the book. I should probably be content with this.
       However, I'm not. The reason for this is that Hector manages to read and actually appreciate my book -- and yet she does not understand some of its most crucial points. Furthermore, her conclusions about my disability are wrong.
       In the beginning of the review, in a very flattering comparison with Joanne Greenberg's I Never Promised You a Rosegarden Hector writes that I am "describing the inner world of a deeply disturbed person". Since the book is an autobiography I understand her to mean that I am and/or have been deeply disturbed. I strongly object to that. Sure, I am disabled -- I have a handicap, a disturbance in my brain functions. But I am most certainly not deeply disturbed, nor have I ever been. High-functioning autism and Asperger's syndrome are not "deep disturbances" -- they are disabilities with a biological cause. Some disabled people can, however, have other sets of problems "on top of" their primary disability.
       Hector continues the review by describing my non-responsive functioning as a state of "psychotic withdrawal". In the book, I have very thoroughly described the difficulties I have from a malfunctioning nervous system -- that I am neurologically and psychologically atypical. I have also described what an effort it is to live with this and how this leads to a need to "unplug" from the world from time to time. This is not a state of "psychotic withdrawal".
       It is my opinion that concepts like psychosis and neurosis are not even applicable on persons with highfunctioning autism since we are so essentially different that very few professionals have enough imagination (and courage) to get a picture of our psyches.
       From what Hector reads in A Real Person she concludes that it is not useful to make interpretations of infantile desires when the client is at a "pre-conflict" stage. What Hector totally overlooks is the fact that I am not at a pre-conflict stage, nor even at a conflict stage, and that her theoretical ground is insufficient to explain my set of difficulties. If I ended up in the chair at Hector's office, I am pretty sure that she, just like my previous therapist, would beleive that I am on the "conflict" stage.
       The truth is that I, a person with high-functioning autism/Asperger's syndrome, have not undergone the same psychological developmental stages as a normal child undergoes. But this has not created the deficits in my maturing process that it would have done in a normal childs psyche, because I did not have all the drives, functions, needs and wishes that a normal child has.
       I am not saying that I do not have any deficits in my maturing process -- I most certainly do! But if you want to understand them (or maybe even to see them) you have to be prepared to put your theories aside and stand on uncharted territory.
       Although Hector recognizes that interpretations of infantile wishes can be humiliating this does not stop her from making such interpretations in the review. Regarding my fondness for curved things she writes: "To me this obsessive stereotypic behavior looks like the manifestation of a longing for the curved forms of the mother, which for various reasons are inaccessible to her".
       To me this interpretation looks like the manifestation of the great fear that many people feel for what is unknown and different, for what is not easily understood by the habitual and comfortable trains of thought. A fear of the things that -- if she assimilates it -- forces a person to reevaluate her positions and see the world from a new angle.
       I also see Hector's interpretations (she suggests more of those in the review) as a manifestation of the fear to lose hope. Psychodynamic theory seems to offer a hope which is essential to its zealots. It is the promise of a Cinderella fairytale for grown-ups where the therapist gets to be the fairy godmother.
       But if the client has an autistic disability with the cause in an injured nervous system then the client will not go to the ball, nor will she meet the prince. The therapist cannot disappear at the stroke of twelwe with her purpose fullfilled. I suspect that this is too difficult for the "fairy godmother" to handle -- this reality cannot be allowed to exist.
       Regarding my urge to bite, Hector writes: "The reader is forced to refrain from interpretations of this odd behavior since we know nothing about the first months of Gerland's life." It seems to have failed Hector that I have described in detail the cause of my urge to bite: the hypersensitivity of my teeth caused by an injured nervous system playing sensory tricks on me. But this explanation does, of course, mean that again there is no psychodynamic knot to untie to make my urge to bite go away.
       So would I, against all odds, be invited to the ball I'd probably bite the prince -- hardly what the fairy godmother had in mind. (But oh, what room for interpretations that would provide!)
       I beleive that psychodynamic therapy is very good for some people who can benefit from it. But to apply this theory to people in the autistic spectrum is a big mistake. If an autistic person is to benefit from any kind of therapy, the therapist must be well-informed about today's knowledge of autism. And please note that this therapy will not make the client less autistic. Increased self-knowledge can, however, lead to better compensations for one's difficulties, which in turn may decrease symptoms and make the autism less disabling. In fact, for some of us psychodynamic theory can be helpful in understanding other people's behavior, which often strikes us as incomprehensible.
       I don't think that all professionals working within the psychodynamic model are like the "zealots" I've described here. In fact, I know they are not. If any reader has inferred that I have a negative attitude towards psychodynamic therapy in general, I regret this.
       In conclusion, I am against the described use of the psychodynamic model. It is insulting and has no meaning. Furthermore, it deprives people with high-functioning autism the prospect of receiving adequate help to understand and cope with their difficulties. If psychotherapists have the psychodynamic model as their only tool, it leads to what is meant in this aphorism: "If all you have is a hammer, everything will look like a nail."
       I am afraid that Hector's way of making interpretations in her review contributes to the spread of misunderstandings about autism and that this, in turn, leads to even fewer persons with autistic disabilities being treated appropriately.

Gunilla Gerland, writer

© Copyright 1996 Gunilla Gerland