Sunday, January 27, 2013

Autism may be precipitated in vulnerable OCD inclined people because of too early separation-individuation from the mother

There is little doubt that autism is more likely to occur in children whose parents are high functioning, socially well off, and obsessional neurotics.

Watching an autistic gentleman who is now in his early Sixties, and who possesses some remarkable abilities though lacking in the most basic skills to live on his own - he lives in a Group Home and requires 24 hour supervision, I was impressed as to how solid his ego was in some areas and yet so remarkably childlike in others. He knows the names and intersections of virtually all major streets of Detroit Metro area, and quite a few of many other cities which he has visited in the past, the birth dates of countless acquaintances, the lyrics of hundreds of songs with all kinds of facts about the ones who sang them. For example this week in the session out of the blue he told me in one breath that Kid Rock was born in 1971, his real name is Robert James Ritchie, he once lived in Taylor and Wyandotte, his son is 18 years old, his first song was Cowboy baby. Then he mumbled something incomprehensible - as if he was having a mini-tourettes - and said that makes him 51 years old. When I contradicted him and said that should be 41, the patient counting on his fingers the decades insisted that no he should be 51 for  between 1971 to 2012 there are 51 years. As to why behind the tremendous memory of obsessional neurotic lies the desire to insult and defy through distorting some aspect of the other person, usually their name or their age, and as a reaction formation (over compensation) one memorizes every trivia about the other person see my post of 9/10/10 "The phenomenal memory of Obsessional Neurotics and Autistic Patients."

But anyway why does this man who is full of knowledge of these trivia cannot use his great abilities in knowing and mastering things that have practical value? What strikes one about him is how the slightest disturbance in his routine throws this man in to a tantrum. Everything has to be done in the same way, and beyond his routine he enjoys nothing. He wants everything to be predictable and in order. The thing that gives him greatest joy is watching a train come down the rails. The train on its tracks is absolutely predictable as to where it will go and how one carriage will follow the next. Nothing in the movement of the train ever goes out of order. The joy in it was not dissimilar to how some autistic children are completely fascinated by revolving musical discs or ceiling fans where the motion is completely predictable with one blade following the next and never getting out of its circle.

In this patient a most telling characteristic is how he wants his needs to be taken care of immediately. The slightest delay makes him angry. In order that his needs get fulfilled immediately he wants very few things. But what he wants he wants right away, without interruption and in a predictable manner. For example when he comes to my office he wants his first cup of coffee the second he enters and the second one about 10 minutes later. He wants exactly same amount of cream and sugar and wants the empty cup to be thrown in the garbage can in exactly the same fashion while he is giving me directions on how to do it. One wonders  whether at a very tender age when his needs (id impulses) were intense and they all wanted to rush out pell-mell, the mother instead of having a feel for it and helping him to let their emergence take place in an orderly manner just left him to deal with it by himself. Or even if tried to help him with it did not have the right sensitivity to the overwhelming emotions that were being generated in the child.  And as a consequence the patient dealt with his helplessness midst the pressure of so many needs to pay attention to a few of them and just ignore the rest, leading to development of an ego organization which became remarkably good and precocious in some areas and completely useless (indifferent) in others. No wonder he had such a remarkable appreciation of the orderly manner of trains where each bogie (need) followed the next in a most consistent fashion unlike the chaos that existed with his needs when his mind chose the autistic path.
It appeared to me as if in many mothers there is lack of fluidity in their feel for their child. Instead of the child being seen as part of oneself and the ego boundaries between mother and child being porous, the mother has too much sense of her own discrete self, separate from the child. Perhaps our highly educated latter day parents belonging to higher socioeconomic strata and having their highly organized career oriented life styles are dealing with their children also in the same highly organized cerebral ways. So in the earliest months of life when the child needs a mother who is not too differentiated from him, who feels one with him and who can sense his needs instinctively as her own, he is saddled with a mother who is full of knowledge from books and other media sources on how to be a good mother without having sufficient emotional and instinctive feel for the child's needs.

This affects the child's development of the ego in two ways. One it encourages him to prematurely develop his own ego, very strongly, very rigidly and very exclusive of anything that looks alien and beyond mastering.  Secondly, the child identifying with the mother develops his ego in her footsteps which due to its high functioning obsessive style has little place for emotions and which values organization and success in the outside world as of greater importance than emotional enjoyment and being one with one's offspring.

The massive size of the brain of autistic child in the first few years of life also may be a reflection of this premature and strong ego development. If a child does not have his mother empathically available to him then he has to hypertrophy his own brain to take care of his needs. The neuronal pruning which is so important for normal growth much of it must occur as a sympathetic response to the behavior of empathic caretakers. A failure of such pruning, along with excessive generation of neurons for strong ego development, may underlie the abnormally large size of autistic children's brains. In our earliest years we are all id (drives) and very little ego. It is the parental ego that serves as "auxiliary ego" providing the necessary wherewithal for the child to survive and develop necessary skills to communicate with others and learn to discharge its id drives in association with others. In autistic children there is a premature attempt to develop an ego when the parental ego behaves in a manner which is not quite right for the child's needs.


Today I read in New York Times an article that supports my above contention: it is failure of neuronal pruning  - because of lack of empathic caretakers - that lies behind the abnormally large size of autistic child's brain. The article titled "Study find that brains with Autism fail to trim synapses as they develop", which was published in the journal Neuron on 8-21-2014,  summarized the findings that at younger age the normal and autistic children have same amounts of synapses. But as they get older autistic children's brains fail to prune normally and their synaptic connections are far more dense.

The author, David Sulzer, of the study summed up his  observation with the quote, "You need to lose connections in order to develop a fine-tuned system of brain networks, because if all parts of the brain, all you get is noise."  Ralph-Axel Muller, another neuroscientist, commented on the study with the statement that autism is problem of overconnectivity.

So in autistic children there is too much internal brain activity going on. And it stands to reason why. If the mother (and other caretakers) are not emotionally and empathically available in the outside world then the baby will start communicating with his own self (his brain instead of communicating with the brains of his caretakers - and thus prune those synaptic connections that are unnecessary for communicating with others - will start communicating within itself.)

It is interesting that Sulzer does not look for the etiology of this failure in pruning to the obsessive-compulsive rigidity of the parents in understanding the needs of the baby. Instead they look for it in malfunction of proteins and other biochemical processes.

It is still not politically correct to look for the primary problem of autism in defective human interactions rather than biology.  

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