Sunday, May 09, 2004

Lurching towards wisdom: neurodiversity and the morality of abnormality

The New York Times > Week in Review > Neurodiversity Forever: The Disability Movement Turns to Brains

Although the text of this article is reasonably respectful, there's scornfulness in the titles, subtitles, and surrounding text. That's not surprising. This logic leads to some directions that will be challenging for most of humanity.
The Disability Movement Turns to Brains

No sooner was Peter Alan Harper, 53, given the diagnosis of attention deficit disorder last year than some of his family members began rolling their eyes.

To him, the diagnosis explained the sense of disorganization that caused him to lose track of projects and kept him from completing even minor personal chores like reading his mail. But to others, said Mr. Harper, a retired journalist in Manhattan, it seems like one more excuse for his inability to "take care of business."...

But in a new kind of disabilities movement, many of those who deviate from the shrinking subset of neurologically "normal" want tolerance, not just of their diagnoses, but of their behavioral quirks. They say brain differences, like body differences, should be embraced, and argue for an acceptance of "neurodiversity."

And as psychiatrists and neurologists uncover an ever-wider variety of brain wiring, the norm, many agree, may increasingly be deviance.

... Science is beginning to clear up such questions, said Dr. Antonio Damasio, a neurologist at the University of Iowa Medical Center, by identifying distinct brain patterns and connecting them to behavior. But, he added, only society can decide whether to accommodate the differences.

"What all of our efforts in neuroscience are demonstrating is that you have many peculiar ways of arranging a human brain and there are all sorts of varieties of creative, successful human beings," Dr. Damasio said. "For a while it is going to be a rather relentless process as there are more and more discoveries of people that have something that could be called a defect and yet have immense talents in one way or another."

For example, when adults with A.D.D. look at the word "yellow" written in blue and are asked what the color is and then what the word is, they use an entirely different part of the brain than a normal adult. And when people with Asperger's look at faces, they use a part of the brain typically engaged when looking at objects.

... For patients, being given a name and a biological basis for their difficulties represents a shift from a "moral diagnosis" that centers on shame, to a medical one, said Dr. Ratey, who is the author of "Shadow Syndromes," which argues that virtually all people have brain differences they need to be aware of to help guide them through life...

In the 1970s, if not earlier, psychiatrists, noting how common "neuroses" were, introduced the idea that perhaps "normal" was a statistical concept (which it is) rather than a categorization. Now we're studying neurophysiology and rediscovering the same idea.

It will take some time for this meme to propagate. Once upon a time Leprosy was a "moral diagnosis" -- the physical expression of depravity. In a just universe only the evil could be so accursed; the alternative was the acceptance of the universe as fundamentally "unjust" -- not a palatable prospect. In the 20th century we struggled to reframe schizophrenia as a disorder rather than a sin. In the 21st century will we one day see sociopaths and pedophiles as disabled?

Physicians, especially internists, who've grown up with the idea of critical diagnostic categories, will have a hard time getting their heads around a continuum of traits with variable degrees of adaptive advantage. This article falls into a similar trap by using the language of "disability". In truth disability is only meaningful in relation to environment. A blind person is disabled in the light, but may be more than able in darkness (relative to most sighted persons). A bit of autism may be a competitive advantage for an electrical engineer. Many writers are easily distracted, flitting from idea to idea. Schizophrenia is probably maladaptive in any conceivable environment, but I suspect the related genes are adaptive in some settings (Shamans and Saints?).

Some readers will intuitively recognize a slippery slope. The more we connect genetics and physiology to behavior, the more we struggle to redefine the closely related concepts of "free will" and "responsibility", and the more we would question our approaches to child rearing, "justice", and punishment. There are already some of us who think "responsibility", like "race", is a social rather than fundamental construction.

Alternatively, if one believes in souls, such research bounds or constrains that which is explained outside the soul; it narrows the range of unique "soulhood".

On the other hand, wisdom is perhaps the art of knowing oneself truly, and then applying one's strengths, friends, family and community to balancing internal weaknesses with internal and external strengths. Those of us who are prone to distraction learn to "work the plan" and "plan the day", we keep task lists and review tactics and strategies. Those who focus relentlessly keep few lists, but ought to set aside time to force exploration of new domains -- less they grow stale and dull.

Lastly, I have long felt that the human brain is a rather feeble construct; a patchwork of hacks and artifacts that barely sustains a shoddy sort of consciousness. If we begin to tweak the hacks, to refactor the cruftiest code, we may produce a qualitatively different entity.