Note: Because Steve Silberman’s book “NeuroTribes” is such a tremendous opportunity for new conversations, I am beginning with a multi-part article discussing my personal experience with Autism and how my perspective compares and contrasts with Mr Silberman’s thesis. The book is an important part of the conversation as much as neurodiversity is a crucial piece of the mystery that is Autism
What is a Paradigm Shift?
In laymen terms, a paradigm shift is a complete change in one’s views. A paradigm shift is a phrase that was popularized by Thomas Kuhn in his influential book “The Structure of Scientific Revolutions” (1962), and used to describe a change or revolution in the basic concepts of a scientific discipline. For Autism, this shift may be from the perception of seeing autism as a disease as to one of a difference in neurology; to be accepted, accommodated for and even valued.
In more scientific terms, a paradigm shift changes the accepted rules and logic of the current framework; the overarching explanatory system. This type of paradigm shift can make us re-evaluate hundreds of years of research and even create new ways to do research.
What is a Framework?
A Framework is a structure, or paradigm, that contains a set of widely accepted assumptions, concepts, values, and practices that constitutes a way of viewing reality. When an established framework is challenged and many take notice, a paradigm shift can occur. Kuhn uses the term “crisis” to explain this radical shift and is a major scientific undertaking. Such that making the change is nearly impossible for those stuck in the old paradigm way of thinking. Only new thinkers, building upon the structure of knowledge of the new framework, can apply it to its fullest capacity. Of course, several frameworks can exist together. One framework doesn’t necessarily negate or trump another. For example, in physics different rules can apply in different realms or layers of reality; such as the very small micro-world and the very large macro-world. Finding one contradictory piece of evidence doesn’t necessarily prove a theory wrong. What it may suggest is we need another layer of rules, or a new framework, to explain the inconsistencies.
Paradigm Shift from Linear —-> Nonlinear
In a linear framework we expect a single cause, or change in input, to create a single change in outcome as we follow those rules. If, by sticking with an obsolete framework when looking at evidence, one ends up dismissing important pieces of information. Proverbially not seeing the forest through the trees.
Linear models are akin to using simple math (one variable equations) for finding all the flat points on a flattened earth (the only way to get points of information). Nonlinear models use multi-variable math to compute all of the points of information as they come together. Flat world science is good for points of information and round world science is good for the complex interactions of the world.
This is where a new framework can help us see through the forest by allowing for the opportunity to utilize the entire collection of evidence.
The Same Paradigm
In the book “NeuroTribes” by Steve Silberman, Silberman convincingly asks us to shift the Autism paradigm. To change from being a disease to one of being a difference in neurology. While this change is a paradigm shift of thought, it is not an actual paradigm shift of a framework.
In a cause-cure paradigm we are presented with two choices. Autism is either a disease or it isn’t. So if one argues it is not a disease, then we are left to assume that autism must be a perfectly healthy way of being. Which is what neurodiversity groups assert; that Autism is “a normal occurrence—an alternate variation in brain wiring or a less common expression of the human genome” (wiki). A further contentions is there is nothing fundamentally wrong with those with autism; that being it is not a disease. Rather, its a genetic glitch that wires unique programming. They contend it is only a disability when society doesn’t accommodate for the sensitivities of that unique genetic glitch. From my personal perspective from living with Autism, there is lot of truth to this and a lot of benefit has come from this fight to understand Autism from this perspective. For example, the Disease Model says “stimming” or repetitive movements is “wrong” and can be “taught” (or punished) behaviorally out of the child. Whereas the neurodiversity view is that the stimming assists with things like concentration and relaxation. This has been found to be quite accurate. Scientifically speaking repetitive movements increase serotonin or dopamine levels which can both be relaxing and help with focus We are beginning to look at things that many Autistics do more holistically and it is a welcomed change. However, that is just a change from one point of view to its opposite. Its not an actual change in framework. This isn’t a paradigm shift at all. Quite the contrary, it is just the opposite way of looking at something within the same paradigm.
The Mysteries of the Black Box
The “cause-cure” linear model is also thought of as “black box” thinking; we have a single outside force that goes through a mysterious box and comes out the other side with an outcome. If you remove the source, then you remove the outcome. However, you have no idea what happens in the box. This is absolutely the wrong type of thinking for autism and stress-induced programming disorders. In order to figure out why different causes have the same outcome and different outcomes have the same causes, like autism, we have to know what is going on inside this box. This is the revolution. If we shift frameworks from the “cause-cure-black-box” paradigm to a nonlinear stress-systems interactive one.
A nonlinear stress model is about looking inside the box and the ecosystem of interactions that go on inside that box (I describe it like a PLINKO Board). There are choices other than the NeuroTribes’s position that autism is not a disease and the biomedical position that it is. And this is in a nonlinear stress-systems framework.
The Stress Paradigm
The many pieces of evidence do not work in a linear disease model, however, they do work in a stress-systems model. This is where the genetic predisposition gets bumped by the environment, altering programming balances and developmental projections. In this theoretical model our unique wiring itself creates our vulnerabilities and our outcomes. It is not a stand-alone disorder that came out of the blue from a single cause, rather autism is something that has always been here to some extent, because its possible 60% of the population could be thought as having autistic-like traits or the Broader Autism Phenotype. What is unique in our time is the amplification of the dysfunctional aspects. Because of many aspects of our environment, including our social construct. All factors we ignored, neglected and created by our scientific framework, which was geared toward a single normal. Silberman doesn’t offer us this option. He unfortunately leads us to believe that pursuing causes are a useless endeavor (since the unique wiring “just happens”). When in actuality moving to a framework that will make sense of the evidence and multi-layered and multi-faceted causes will ultimately do what Silverman wants to do… find and justify the accommodations and implement real-world solutions for those on the spectrum.
Stress and our Modern World
Silberman states page 470: “…society continues to insist on framing autism as a contemporary aberration— the unique disorder of our uniquely disordered times— caused by some tragic convergence of genetic predisposition and risk factors hidden somewhere in the toxic modern world.”
My answer is: Yes, we do insist on framing autism as a contemporary aberration unique to our times caused by a convergence of gene and environment.
The problem, however, has been in pursuing these factors as single sources or even single gene-environments. Combined* sources instead of pursuing these factors in a holistic stress-systems manner. Using chaos dynamics like ecosystem weather patterns in particularly stress climates.
Stress is not a new aberration of our modern world. It has existed constantly throughout our evolution (stress as a framework is the way we communicate, adapt and respond to our environment, it IS evolution). We have always pushed the boundaries of what our minds and bodies could do. In this way the neurodiversity crowd is correct. Autism most likely, in one form or the other, always existed. However, evolutionarily speaking we have never faced this unique combination of stresses and we have never had the decline and the metaphorical “rug pulled from under us” in resource availability. That is unique. Additionally, what is further unique is we never had a science of “if there is a cause, get rid of it” and a single source of normal dominating our culture. It’s unique that we have a science framework itself as being part of our undoing; toppling delicate ecosystems out of balance. While, neurodiversity could certainly make an argument for where does one begin and the other end (and this will be the future of many fun debates and advancements in science), I would say the research supports the idea that we are currently undermining our ability to handle and stay regulated appropriately to the environment under our current burden of stress. And we are experiencing greater expressions and dysfunctional aspects of autism in our current population as a result.
From Silberman recently airing on NPR: “How society deals with autism” (NPR September, 9th 2015)
Autism is a highly complex and heterogeneous condition that is probably caused by a highly complex and heterogeneous series of interactions between genes and the environment. But one of the arguments that my book makes is that we think that our society is taking autism seriously and dealing with the challenges that it presents by pouring millions of dollars into it. [They’ll say,] “Let’s find more candidate genes.” Well, we already have 1,000. “Let’s find more potential environmental triggers.” Well, everything from antidepressants in the water supply to air pollution has been identified as possibly contributing to autism.
One of Mr. Silbermans main points is that he stands against Autism Speaks and other research organizations that spend most of their focus and money on research to find individual genes (thousands) and individual environmental influences (to which there are likely hundereds). I agree this is problematic, but clearly not for the same reasons as he. When I describe the problem with pursuing individual genes it is because it is synonymous with looking at the tips of roots of a tree. You will not find the “climates” that create stress vulnerabilities in this manner. The tips of roots are too diverse. What is a more fruitful pursuit, in my opinion, is the neuro-behavioral hubs of what we think of as personality, temperament and thinking types (See my autism thesis). These are climates, or initial conditions, we can use to see the patterns of vulnerability, the patterns of stress resource impairments and the diverse outcomes of stress threat management and energy preservation.
This is the true paradigm shift. From thinking that answers had to be the gene or the environment, to a true interactive science. Assuming we could separate the gene from the environment is just like as we assumed we could separate various organ systems like the immune from the digestive and the mind from the body. We can not separate these things at all. We need to move from flat world science to a round world science. In the flat world, separating these things gave us information, but in the round world, the real world, they all intimately interact. The gene-environment, immune-digestion, the mind-body, communicate, share resources and play off of each other. And we need to start operating a scientific framework that integrates them, like a stress-systems model would.
Silberman goals are admirable, but he doesn’t have to ask us to ignore evidence or the pursuit of causes in order to accomplish it. Because what we really need to do is change the framework in which we view them.
*gene-environment combined is often still reductionistically looking for single genes and their single environmental counterparts such as how Autism Speaks and Google are currently pursuing.