Against Against Autism Cures

[Content warning: autism, disability, psychiatry, abuse]


Vox: We’ve called autism a disease for decades. We were wrong.

I have mixed feelings about this. On the one hand, I know and like many people in the autism rights movement. They defend autistic people’s right to avoid psychiatric care if they don’t want it, and this fits well with my own position that (outside of emergency situations) everyone should get to choose whether or not they want psychiatric care. They also do good work exposing abuse of autistic people and ideas that promote such abuse, and calling out organizations that claim to speak for autistic people but don’t do a very good job. And they provide great resources that help autistic people and their friends and families. Ninety-nine percent of what they do is unquestionably great.

Yet somehow, whenever I hear about them in the media, the article is titled either “Autism Is Not A Disease” or “Stop Trying To Cure Autism”. I don’t know if it’s just the usual controversy-mongering or whether this really is at the center of their philosophy, but they manage to consistently emphasize the one percent of their philosophy I can’t be on board with.

All psychiatric categories are a mishmash of unlike things crammed together under a single name. Depression ranges from people who put on a normal facade but feel empty inside, all the way to people who are totally catatonic and can’t move or speak. Schizophrenia ranges from people who are totally okay as long as they take their medication, all the way to people who talk in “word salad” because their thoughts are so malformed that they can’t even make complete sentences. But even among diagnoses like these, autism takes the cake in terms of heterogeneity.

I kind of a have a front-row seat here. On the one hand, about half my friends, my girlfriend, and my ex-girlfriend all identify as autistic. For that matter, people keep trying to tell me I’m autistic. When people say “autistic” in cases like this, they mean “introverted, likes math and trains, some unusual sensory sensitivities, and makes cute hand movements when they get excited.”

On the other hand, I work as a psychiatrist and some of my patients are autistic. Many of these patients are nonverbal. Many of them are violent. Many of them scream all the time. Some of them seem to live their entire lives as one big effort to kill or maim themselves which is constantly being thwarted by their caretakers and doctors. I particularly remember one patient who was so desperate to scratch her own face – not in a ‘scratch an itch’ way, but in a ‘I hate myself and want to die’ way – that she had to be kept constantly restrained, and each attempt to take her out of restraints for something as basic as going to the bathroom ended with her attacking the nurse involved. This was one of the worse patients, but by no means unique. A year or so ago, after a particularly bad week when two different nurses had to go to the emergency room, the charge nurse told me in no uncertain terms that the nursing staff was burned out and I was banned from accepting any more autistic patients. This is a nurse who treats homicidal psychopaths and severely psychotic people every day with a smile on her face. When she says “autistic”, it seems worlds apart from the “autistic” that means “good at math and makes cute hand flap motions”. When a mental health professional says “autistic”, the image that comes to mind is someone restrained in a hospital bed, screaming.

The Vox article doesn’t deny any of this. Matthews admits that “people have a image of autistic people as these completely nonverbal children banging their heads against the wall” and his interviewee Silberman describes how autistic children in institutions, when left alone, would “end up chewing through their own finger”, which pretty much 100% matches my expectations of what my autistic patients would do if the nurses weren’t there to watch them.

But as per Matthews and Silberman, this is just a consequence of the maltreatment these children receive in institutions:

What society thought of as the natural course of autism was actually a very skewed view of what happened to autistic people when they were put in institutions. For decades, the recommended course of treatment for autism was institutionalization.

Parents were routinely told they should put their child in an institution, quietly remove their photographs from the family albums, never speak of them again, and enlist in decades-long courses of psychoanalysis to think about why they were motivated to wound the developing psyches of their children.

When children were put in institutions for the rest of their lives, it wasn’t like they were put in specialized autism wards. There was no such thing, with very few exceptions. They were mostly put on psych wards for adult psychotics. Oliver Sacks worked on such a ward, Ward 23 at Bronx psychiatric, in the 1960s. He told me that some of the children and young adults would be put in straight jackets and isolation rooms to sit in their own waste for weeks on end. The children and young adults became self-injurious, which is not a surprise at all. If you treat people brutally, they’ll react in extreme fashion.

Be sure to read the rest of the article for more horror stories about the ways autistic children were treated; this sort of stuff was all too common, slightly-toned-down versions of it are still too common today, and this is why I agree with ninety-nine percent of everything the autism movement says.

But then they start talking about how we don’t need a cure.


The popular literature about autism tends to fall into the genre of “Doctors hate her! Area mom cured her child’s autism with This One Weird Trick!” Common One-Weird-Tricks include gluten-free diets, casein-free diets, massive multivitamin doses, and whatever else the cutting edge of quackery can dream up. The autism rights people are rightly suspicious of this entire category.

But I worry they have their own One-Weird-Trick: treating autistic people decently.

You should treat autistic people decently because it’s the right thing to do. But it is not One-Weird-Trick. Avoiding abusive treatment will prevent things from being worse than they have to be, but that’s all. It will not turn severely disabled people into independent, happy-go-lucky angels. Parents, caretakers, and doctors can do everything right, move heaven and earth to accommodate an autistic person’s every need and limitation – and they will still suffer.

Some of this is purely biological. Thirty percent of autistic people have comorbid epilepsy, often very severe. Over half of autistics are cognitively disabled. Autistics have three times the risk of Tourette’s Syndrome, five times the risk of cerebral palsy, about a hundred times the risk of tuberous sclerosis, and various balance and coordination disorders, plus an increased rate of other psychiatric disorders like bipolar and schizophrenia. There are treatments for these conditions, both pharmacological and otherwise, but they come with their own set of side-effects and difficulties and none of them are 100% effective.

And some is behavioral – but as far as I can tell in no way limited to maltreated or institutionalized autistic people. Half of autistic children self-injure, and more than half of autistic children and adolescents are physically aggressive. Autistic children are twenty-eight times more likely to be suicidal than other children. Three-quarters have eating problems ranging from “picky eater” to “will not eat food, good luck doing something about this”. About two-thirds have “sleep disorders”, which is sometimes a euphemism for “wakes up screaming in the middle of the night and will not stop”. As best I can tell, all these studies were done on non-institutionalized autistic people who were generally well-treated and still living with their parents.

And yes, institutionalization adds a whole lot of extra suffering to the mix. But even here, I find Matthews’ narrative overly simplistic. He talks of a world where random doctors swoop in and trick parents into sending their children to institutions out of pure prejudice and stigma. Anyone who’s ever worked with these families has seen something very different. These parents aren’t poor deluded rubes who have been tricked by stigmatizing doctors. They’re well-educated, deeply committed to their children – and desperate. They’ve spent years trying to raise kids who were violent, self-injurious, locked in a sensory hell without the ability to explain their problems verbally, and maybe having seizures all the time to boot. Their decision to institutionalize is a reluctant concession to this reality. I do not feel the slightest bit of qualification to pass judgment upon these parents and I invite anybody who does to spend a few moments talking to them. Unless you can give these parents a better option – and trust me, they’ve looked – institutionalization isn’t a moralistic tale of prejudice and stigma in the medical system. It’s just a few more drops of misery added to the vast morass of suffering that is severe autism.

Matthews and Silberman speak dismissively of Leo Kanner’s view that autism was caused by bad parenting, but I worry we’re headed right back in that direction. Start telling people that the only reason autistic people have all these problems is because of institutional abuse, and someone’s going to ask “But what about all these autistic people living with their parents who also head-bang/attack people/try to kill themselves?” Then you can either admit that sometimes autism just sucks no matter how good an environment you’re in, or blame the parents for not making the environment good enough. And once you’ve made “autism isn’t a disease and nobody needs a cure!” into your rallying cry, it’s going to be hard to choose that first option.


If we can’t make all autistic people independent and well-adjusted with One Weird Trick, then we have to consider how real autistic people actually turn out. The numbers aren’t good.

Outcomes In Adults With Autism Spectrum Disorders: A Historical Perspective reviews all of the autism outcome studies of the past fifty-odd years. Most of it is nitpicking different people’s definition of “poor” outcome versus “very poor” outcome, but let me try to extract the easily quantifiable bits1.

Six studies have assessed what percent of adult autistics have a job – they find 22%, 21%, 31%, 4%, 4%, and 4%. The two that found rates in the twenties limited themselves to high-IQ autistics and so are unrepresentative.

Four studies assessed institutionalization rates among adult autistics, although these “institutions” form a very heterogenous category from homey group houses to super-intense locked hospitals. These studies find 35%, 43%, 48%, and 53% of adult autistics to be institutionalized.

A few studies looked at other outcomes. Two investigated what percent of adult autistics still lived with their parents. Both estimated about 50%. This is in addition to the 40% or so who are institutionalized, so only about 10% of adult autistics live independently.

One study investigated how many autistics have at least one friend and found it was just under 50%.

I cannot find any studies on adults with autism per se, but adults with Asperger’s (recently collapsed into the autism diagnosis) are ten times more likely to be suicidal than other adults.

I realize this seems extreme2, but I think it really puts into perspective the difference between the conventional “shy person who likes trains” view of autism, and what psychiatrists and scientists really mean when they talk about an autism diagnosis. The happy, independent autistic people whom most of us know and whose stories get told in the media are four to ten percent of the autistic population. What about the other extreme, the forty percent who are institutionalized?

I hate to have to criticize institutions – an umbrella term I’m using to cover group homes, locked facilities, nursing homes, hospitals, etc. Many are run by amazing and caring people who are doing thankless work on shoestring budgets. I’m humbled by the patience and compassion I’ve seen in their staff of nurses, techs, and other caretakers, and I can’t judge them nor claim that I could do their job for one minute.

That having been said, a lot of institutions are kind of hellish.

I’ve seen institutionalized patients who were sexually abused, physically abused, or just neglected and left to wander out into the street. Lest you dismiss this as crazy people making things up, some of the allegations later got confirmed by police investigations.

Other times it doesn’t rise to the level of anything criminal, just the usual petty tyranny you expect any time somebody gets to control somebody else’s life. I got consulted for “medical management” of an autistic man who had smashed a bunch of holes into the wall of his group home. He needed his mp3 player to control his noise sensitivities, but the staff had taken it away as punishment for breaking some rule or other. He decided a proportionate response was to smash several holes in the wall. To his credit, it worked; my diagnosis was “give him back his fricking mp3 player, you morons”.

But even when the institutions are well-run, non-abusive, and dare-I-say-it-even-nice, the whole structure just makes a perfectly bad fit with autistic people. Remember, autistics are known for intense sensory sensitivities and pickiness about their environment. Take someone who can remain stable as long as there are no unexpected loud noises, and make him share a room with a guy who screams at the top of his lungs every couple of minutes for no reason. Or take someone who will eat about 1% of foods, and only if they’re perfectly prepared, and then stick him in a hospital where the catering service lets him choose from a menu of two meals, and they’re always out of one of them. Or take somebody who freaks out about the feeling of different textiles, and tell her she has to sleep in a mass-produced hospital bed with exactly the same sheets as every other mass-produced hospital bed.

I have some very minor sensory sensitivities, and they drive me nuts. But at least they only metaphorically drive me nuts, That’s because I’m an independent middle-class person who can throw money at problems to make them go away. I have no tolerance for stray noise, so I pay a little more than I should for housing and live in a quiet area outside town. I can’t stand constricting or scratchy clothing, so I only wear loose-fitting clothes, extend the collars, and cut off all the tags. It works pretty well – but only because I have a lot of control over my life. Put me in an institution where other people manage everything about my daily routine, and my life would fall apart. And my sensitivities are a fraction of a fraction of what real autistic people suffer.

The hospital I work in really does try hard to make things more tolerable for our autistic patients. It’s never enough. Fix all of the contingent things, and you just bump up against the fact that humans were not designed to live in psychiatric hospitals, autistic humans least of all.

I have met many well-intentioned people who believe that institutions are only bad because of stigma against the mentally ill, or insufficient budgeting, or ignorance of people’s true needs. These people should visit a nursing home someday. The people there don’t have some kind of exotic stigmatized hard-to-understand condition. They’re just old. Yet nursing homes and other institutions for the elderly have every bit as many problems as the institutions for autistic people.

I don’t think that mental health institutions will get better anytime soon, because I would expect the average person to be a lot more concerned with nursing homes – where their grandparents live! Where they themselves will end up one day! – than they are with mental health institutions. If we can’t even get our act together on that one, what hope do we have for the harder problem? Having good involuntary communal living institutions is just plain beyond us as a civilization at this point. It has nothing to do with stigma or prejudice. Even if everybody loved autistic people exactly as much as they love their own grandmother, the best we could hope for is institutions that treat autistic people as well as they treat grandmothers. Which is to say, abysmally.


Dylan Matthews says that autism “is not a disease”, joining writers from TIME, The Guardian, The Irish Examiner, various blogs, et cetera. I would hate to contradict such an array of eminent voices.

So let’s taboo whether something is a “disease” or not. Let’s talk about suffering.

Autistic people suffer. They suffer because of their sensory sensitivities. They suffer because of self-injury. They suffer because they’re in institutions that restrain them or abuse them or just don’t let them have mp3 players. Even if none of those things happened at all, they would still suffer because of epilepsy and cerebral palsy and tuberous sclerosis. A worryingly high percent of the autistic people I encounter tend to be screaming, beating their heads against things, attacking nurses, or chewing off their own body parts. Once you’re trying to chew off your own body parts, I feel like the question “But is it really a disease or not?” sort of loses its oomph.

My moral philosophy doesn’t contain a term for “is this a disease or not?”, but it definitely contains a term for suffering. If you’re a good person, you try to alleviate or prevent suffering. Accommodating and supporting autistic people alleviates some amount of the suffering associated with autism. Curing it alleviates all of that suffering.

And remember – society is fixed but biology is mutable. Which do you think is more likely? That soon biologists will discover a molecular cure for autism? Or that soon politicians will discover a cure for the systemic issues that cause poor people who can’t stand up for themselves to be maltreated and abused? The biologists seem to have about a ten million times better track record for this sort of thing. And if you don’t expect the politicians to create a brave new world where no disability ever remains unaccommodated, then stopping the biologists just means that the status quo will go on forever.

Faced with the choice of seeing the flood of human misery that I have to deal with every day continue mostly unabated, or having a pill that provides a quick fix to said flood, I wish with all my heart for the latter. Sure, this should not be pursued at the cost of supplying what accomodations to existing autistic people we can, any more than blue sky cure-for-cancer research should be pursued at the cost of treating current cancer patients, but it’s right and proper to want it, to think it would immensely improve thousands of people’s lives.

Would something be lost if autism were banished from the world? Probably. Autistic people have a unique way of looking at things that lets them solve problems differently from everyone else, and we all benefit from that insight. On the other hand, everyone always gives the same example of this: Temple Grandin. Temple Grandin is pretty great. But I am not sure that her existence alone justifies all of the institutionalizations and seizures and head-banging and everything else.

Imagine if a demon offered civilization the following deal: “One in every hundred of your children will be born different. They will feel ordinary sensations as exquisite tortures. Many will never learn to speak; most will never work or have friends or live independently. More than half will consider suicide. Forty percent will be institutionalized, then ceaselessly tyrannized and abused until they die. In exchange, your slaughterhouses will be significantly more efficient.”

I feel like Screwtape would facepalm, then force him into remedial Not-Sounding-Like-An-Obvious-Demon classes.


My medical ethics have always said that outside emergencies, people who want psychiatric help should be able to get it, and people who don’t want psychiatric help should be able to refuse it.

So when autistic people say they don’t want cures forced on them, I say – fine. If you’re happy with your autism, and it’s not hurting anyone else, keep it.

But when they say we should stop all research into cures so that nobody else can have one either even if they want it, that’s a different story. When they say that, well, then I’m not the one dictating to other people what neurotypes they are or aren’t allowed to have.

When I see an autistic guy in a hospital room screaming and trying to chew their fingers off, I feel like that guy would probably want a cure for autism. Granted, that guy can’t always talk and tell me what he does or doesn’t want. But he certainly doesn’t seem happy with the status quo. And some autistic people, even some very high-functioning autistic people, have told me straight out that they want to be cured. Who the heck are we to tell them their desires are wrong?

More controversially, I think caretakers who wish there was an autism cure that could relieve them from the responsibility of caretaking have a valid wish. Nobody is entitled to another person’s life. A schizophrenic man has the right to stay off antipsychotics, but his wife has the right to make an ultimatum: “I can’t deal with you being schizophrenic, either you take your meds or I’m leaving.” Likewise, an autistic person has the right to stay autistic, but a caretaker has the right to say “This caretaking is too much for me, either take the cure or find somebody else.”3

Even more controversially, I think parents have the right to decide if they want to have an autistic child or not. I am generally pro-choice. As best I can tell fetuses have less personhood than cows, and I had a cheeseburger for dinner last night. If someone wants to abort a fetus because their pregnancy was an accident, because they don’t feel ready to have a child, because there’s some kind of problem in the family – all of those seem to me like a decision that a mother is perfectly within her rights to make, because fetuses are not very important moral agents. And if instead of just “I don’t want a child”, an expecting mother is worried because she doesn’t think she will have the resources or compassion or strength of will to take care of an autistic child, that is also her decision to make. Also, I feel like if your whole argument is that autism only goes badly when autistic children are mistreated, maybe you shouldn’t be simultaneously demanding that women who really don’t want autistic children and don’t believe they can take care of them should be forced to have them anyway. On the other hand, if a mother wanted an autistic child, and she was somehow sure that she could support that child and help him or her flourish, I would be okay with her aborting however many neurotypical fetuses it took.

But even more controversially, absent such certainty that your child will flourish I think if some kind of genetic-engineering autism-cure existed, parents would have a moral obligation to use it. Consider an analogy to fetal alcohol syndrome. People with fetal alcohol syndrome seem less happy, less able to achieve their goals, and more likely to suffer than people without the condition. Therefore, we have a very strong social norm that you shouldn’t drink too much during pregnancy. But people with autism also seem less happy, less able to achieve their goals, and more likely to suffer – in fact, autism shares a lot of symptoms with fetal alcohol syndrome, like seizures and intellectual disability. The moral imperative to take the hypothetical-genetic-autism-cure during pregnancy seems as clear as the moral imperative not to drink alcohol, and for the same reason4.

I don’t mean to propose a zero-sum game here. All sorts of breakthroughs and possibilities could give both sides everything they want. Maybe there is some way to alleviate some of the more distressing symptoms of autism while leaving the deeper and more cognitive parts intact. I don’t think anyone wants, as a terminal value, for people to be intellectually disabled or have more seizures. If Dylan Matthews were to list all of the things he likes about autism, and I were to list all of the things I don’t like, maybe there wouldn’t be anything on both lists. And maybe the bad things are controlled by separate genes from the good things, so that we could turn off one set of genes and not the other.

And I’m still in favor of basic income. If everyone gets a basic income, autistic people who want to spend it on getting the care and support they need to remain autistic could do so without costs to anybody else. I do hope that there will be only a very short stretch of time between the development of technology that can genetically engineer people at will, and solving the scarcity problems that make our desires sometimes demand sacrifices of others.

And maybe the best option is that somebody develops technology that can change your brain type during adulthood, so that everyone has the option of experiencing life as an autistic person and as a neurotypical person and seeing which is best for them. Invent something like that and the problem disappears.

And a lot depends on the genetic structure of autism. If autism is just the brain’s response to high mutational load, then trying to do most other good things will prevent autism as a side effect. On the other hand, if autism is the extreme version of a trait whose common version is “good at logical and scientific thinking”, then we have to ask ourselves whether that trait is worth messing with. As usual, everything about genetic engineering raises thorny scientific and ethical quandaries, and I can only hope we don’t drag our feet in creating the eight-foot-tall IQ 300 supermen who can solve them.

And maybe all of this is silly, because we don’t have an autism cure and we’re not even very close to one, and maybe when people talk about whether we should use the autism cure we don’t have, it’s all a metaphor for “respect my tribe” and “I demand my rights” and “here’s a good controversial lead-in to a story about how you should treat autistic people like human beings” and maybe even if I’m right about the literal moral dilemma I should support the opposite side for totally symbolic reasons.

But if, after all this, it really does comes down to a binary “cure autism/don’t cure autism” decision, I know which side I’m on.


1. In a way, all of these numbers are meaningless. If you define “autism” so broadly that it includes Dylan Matthews and me, maybe less than one percent of autistics are in institutions. If you define “autism” so strictly that you only count institutionalized autistics, then one hundred percent of them are. So really what these studies are saying is “We chose to define autism at a level where forty percent of autistics are in institutions”, to which one response is “And why should I care what level you chose to define autism at?” But I think these studies at least tell us two things. First, that the formal psychiatric definition of autism is much stricter than the popular one, and we combine the two categories at our peril. And second, that this former category of very severely ill autistics exists and contains many people we might not otherwise notice.

2. The employment and living-with-parent numbers don’t seem to have changed much over time; the institutionalization number has decreased over the past few decades. This probably reflects a general trend toward deinstitutionalization throughout the mental health world. So far there is little sign of autistic people doing great now that the most abusive 60s-style institutions have been curtailed. But perhaps this just hasn’t shown up yet; these are studies of adult autistics; even the youngest were born in the 1980s, and the autism world has changed a lot since then. I’d say that I will be interested to see a similar study in 2030, but I think by that time the diagnostic category will have become so confusing that nothing will be comparable to anything that came before it.

3. Even more controversially, I think the government has the right to do the same. The lifetime cost of supporting an autistic person is $1.5 million, not including productivity loss of the person themselves. Much of this is borne by the government. The average taxpayer will give about $500,000 over their lives, so it takes three non-autistic people to support each autistic person – even ignoring all other essential government services like schooling and welfare and giant nuclear missiles. Of course, helping the needy is exactly the sort of thing the government should be doing, and right now the government ought to do whatever it takes. But if there is a cure for autism and autistic people choose not to take it but still want the $1.5 million, then the government has the right to start thinking things like “we could lift a whole lot of destitute families out of poverty for $1.5 million.” Everyone has the right to choose their neurotype, but I’m not sure they have the right to make other people subsidize it.

4. Prof. Mora LeQuivalence: “Interesting point! Let me propose a similar argument that you might have a more personal stake in. Why don’t we genetically engineer away nerdiness? Everyone knows nerds are less happy than normals, at least in high school.”

Scott: “The cost-benefit calculations are totally different. Nerds are probably unhappy, but less so than autistics. And while autistics can claim Temple Grandin, nerds can claim pretty much every decent scientist and mathematician of the past few centuries, plus all the good sci-fi/fantasy writers.”

Mora: “Fine then. Keep the nerds around until they build robots that can do math and science and art. Then we won’t need them anymore and we can get rid of them.”

Scott: “Look, we can’t do all of this based on broad principles. There’s a balance between having a wide variety of human experiences versus having some of them be hellish. Few people want all individuality collapsed into a planet-sized chunk of hedonium, and few people think that a couple of expecting mothers should drink lots of booze to protect the vital diverse human experience of fetal alcohol syndrome. You’ve got to make your own choice about where to draw the line, and I draw it somewhere south of nerds and north of severe autism.”

Mora: “That’s a very interesting argument.”

Scott: “It better be, I stole it directly from God.”

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862 Responses to Against Against Autism Cures

  1. ilzolende says:

    I have lots of nitpicks about this article.

    Thing I should say up front: My true rejection is probably part “ingroup members need to continue to exist in the future, if we can’t do this through cryo or the status quo I am just going to have to have a bunch of autistic babies and that will not be fun, if the future is going to be 100% neurotypicals it is going to be awfully tempting to not prioritize making the world a nice place after I die”. This is not a moral reaction. But people probably deserve to know that I am having it.

    If we buy the whole “animals are at near-human levels of importance” argument (I don’t), then this is possibly a good deal, Grandin did a lot of pain-minimizing stuff. I do not think this is not a good deal, because I am a rabies-avoidant speciesist. It is also not the deal being offered. Personal experience leads me to assign a lot of credence to the idea that “autism is the extreme version of a trait whose common version is ‘good at logical and scientific thinking'”. It’s been shown to be correlated with having siblings majoring in STEM fields. (Anecdotal “evidence”: Both of my grandfathers and my father are/were professors in such fields, and my mother has a master’s degree in one. One of my grandmas doesn’t have a degree, but the other one was a lawyer for a long time. Let’s just say I won’t be surprised if I find out that the same genetic factors affect both.) If you can do enough screening to get way lower levels of autism and still have all my barely-allistic relatives end up existing, that’s great, but people are probably going to be way more concerned about not having an autistic child than they’ll be concerned about preventing false positives.

    Also, on autonomy issues: “So when autistic people say they don’t want cures forced on them, I say – fine. If you’re happy with your autism, and it’s not hurting anyone else, keep it.” It’s not going to be that simple. I’m a minor. People could dump me in the JRC or require me to wear a tracking bracelet or whatever if they wanted to. I, however, have a pretty good safety net and am also more persuasive than the average autistic person: If someone decided they wanted to try and require me to take an autism cure, I could probably avoid being forced to do so. I do not expect that the average autistic minor who wants to stay that way would be so lucky. Sure, in an ethical society this wouldn’t be an issue, but let’s try and get minors a few shreds of bodily autonomy first (I can’t take a picture of myself and possess it, this is ridiculous) and try and develop an autism cure second.

    Also, arguments about cost to society probably have nonzero validity, but System 1 keeps dismissing them via Godwin’s Law. (Not constructive feedback, sorry. IDK if rephrasing the footnote would get other people’s System 1s to calm down.)

    • Nornagest says:

      “autism is the extreme version of a trait whose common version is ‘good at logical and scientific thinking’”

      High IQ is correlated with a ton of mental problems, including bipolar disorder, depression, OCD, and a bunch of anxiety-related issues. I also suspect, though I don’t have data, that the list would expand if you included shared family history; there’s a lot more mental problems that’ll sink an IQ test even if you’d otherwise expect the person to be bright. Autism may be on that list, though the brief literature search I did didn’t turn up anything promising.

      But I think it’s deeply unlikely that any of those disorders are causally rooted in facets of IQ (f’rex, math skills). There are just too many of them, for one thing; when you see that many correlations in a single domain you go looking for a common cause, and most of them don’t even have the weak stereotypical links with logical reasoning that we see with autism spectrum disorders. It seems more plausible just to say that high mathematical ability is an extreme trait and that extreme mental traits tend to correlate with each other, probably for roughly the same reasons that overclocking a silicon chip makes it more likely to let out the magic blue smoke.

      (I’m also just generally skeptical of flattering explanations for these sorts of things.)

      • Marc Whipple says:

        Autism is definitely on that list.

        My daughter, who has been diagnosed autistic since the age of 3, has a measured IQ of 55. Even the psychometrician who administered the test thought this was ridiculous. (She apologized, for God’s sake.) Nobody who spends an hour with her (when she’s not freaking out about strangers asking her stupid questions) would believe that her cognitive ability was that low. But because of her communications problems, that was the score she got.

        I have a pet theory, in fact, that she’s actually more impaired by her autism than she appears to be, but that she’s so intelligent that she finds workarounds for some of the things it would otherwise be difficult or impossible for her to do.

      • sconn says:

        I think we can’t even do the first step toward curing autism till we know the cause. And while obviously I have no idea what causes it, it seems a possibility that it’s one of those things that, if you have one gene for it, it’s great, and if you have two, it’s horrible. (Though surely it’s way more complicated than that.) For instance, sickle cell anemia — the genes remain because it’s useful to have one, but the downside is that it’s really bad to have two.

        My family clearly has some of the genes in question. One of my brothers has some variation of ASD and another is getting evaluated for it soon. But there isn’t a huge difference amongst the six of us: except for one very normal brother, we are all extremely bright, highly sensitive, socially awkward, can’t throw a ball to save our lives, fidgety, etc. Now I have kids of my own, and sure enough one of them is very much of the same type, perhaps a bit more than most of my siblings. And my spouse is also nerdy, picky, sensitive, etc.

        I’m sitting here thinking — is this my fault? Should I have married a more average person? My son is managing okay so far, mostly, except when he has to talk to other adults besides us, or when his routine is disrupted or whatever. But what if this causes him hardship later in life? What if we had another child who was severely disabled? Should we be telling nerdy people not to marry other nerdy people or to adopt children to avoid the risk of bearing severely autistic children?

        I don’t have an answer to this.

    • J says:

      | I’m a minor.

      Unfortunately, minors are one of those groups of people our society is still okay with treating like they’re less than everyone else, so your problems are far more general than not getting to choose about autism treatment. Fortunately, it does seem to be slowly getting better over time, and for what it’s worth, I think minors’ rights are a totally valid political issue that you can promote right now and vote on in a few short years.

      • brad says:

        I don’t see a general trend towards things getting better. Of the three potential power loci — minor, parent, state — I’d say the distinct trend over my lifetime has been increasing power to parents.

        • Marc Whipple says:

          And lately, to state over both. When you can go to jail for letting a ten-year-old play in the park unsupervised, that ain’t a parentally-oriented system.

    • Besserwisser says:

      The deal offers way too little on the side of autism once you consider all the people in history being “diagnosed” with autism retrospectively or from a distance. You’d be foolish to believe all of those actually had autism but you would also be foolish to think no scientist ever did contribute to society precisely because of different thought pattern coming with being on the spektrum.

      Going on about what good biologists brought upon mankind before the only mentioned positive contribution assigned to autistics is portrayed in a way which makes it seem the least positive is probably my biggest bugbear about the whole text.

    • RCF says:

      “(I can’t take a picture of myself and possess it, this is ridiculous)”

      False as stated, and all reasonable interpretations that I can think of are also false, at least under US law.

      • HeelBearCub says:

        Sexually explicit would probably do some work here, at least in the US.

      • Who wouldn't want to be Anonymous says:

        In particular.

        While at least 20 states have updated their laws since 2009 to address teen sexting, in others, images teens produce are treated like child pornography, with harsh penalties for possession.


        Between 2008 and 2009, cops handled an estimated 3,477 cases of youth-produced sexual images, according to a national survey of law enforcement agencies taken by researchers at the University of New Hampshire. Two-thirds of the cases involved an aggravating circumstance beyond creating and sending the image — for example, an adult was involved or the teen engaged in non-consensual behavior.

        That still leaves a thousand cases of teens being subjected to law enforcement that didn’t include an aggravating circumstance. This is exacerbated by how absurdly broken plea bargaining is and the incentives prosecutors have to overcharge.

        • RCF says:

          “That still leaves a thousand cases of teens being subjected to law enforcement that didn’t include an aggravating circumstance.”

          A thousand cases that didn’t include an aggravating circumstance beyond creating a sexual image, and sending it. Both “sexual” and “sending” were elements not specified in the original post. It is perfectly legal to possess photographs of children. And while possessing photographs of naked children does expose oneself to the danger of overzealous prosecutors, it is protected by the first amendment.

          • Who wouldn't want to be Anonymous says:

            Your negation is inaccurate.

            A thousand cases that didn’t include an aggravating circumstance beyond creating a sexual image, or possibly sending it to a minor were all parties consented to the exchange.

            Also, the supreme court has explicitly denied pornography from first amendment protection while failing to decide what pornography actually is. “I’ll know it when I see it” is not a useful rule, and leaves prosecutors infinite latitude.

            Sexual images are a subset of all images, and were therefore included implicitly in the original. Sending is not required. The article I linked, for example, is about a teenager who is (was?) facing four counts relating to child pornography simply for possessing (sexual) pictures of himself. (And one count for possessing a picture his girlfriend took [the article was ambiguous about who the subject was, but I assume it was her]. Notice that she isn’t facing any charges, despite taking a picture, possessing it at least temporarily, and then distributing it to him.)

          • brad says:

            “I know it when I see it” isn’t the standard anymore. The current obscenity test has the following prongs:
            (1) whether ‘the average person, applying contemporary community standards’ would find that the work, ‘taken as a whole,’ appeals to ‘prurient interest’ (2) whether the work depicts or describes, in a patently offensive way, sexual conduct specifically defined by the applicable state law, and (3) whether the work, ‘taken as a whole,’ lacks serious literary, artistic, political, or scientific value.

          • RCF says:

            “Your negation is inaccurate.”

            If you’re going to assert that my negation is inaccurate, then you should clearly identify who negation you think is inaccurate, and how it is inaccurate.

            “A thousand cases that didn’t include an aggravating circumstance beyond creating a sexual image, or possibly sending it to a minor were all parties consented to the exchange.”

            No, not “or”, “and”. And you presumably meant “where” rather than “were”.

            “Also, the supreme court has explicitly denied pornography from first amendment protection while failing to decide what pornography actually is.”

            No, the Supreme Court has explicitly stated that pornography is protected by the first amendment. What is excluded is obscenity. Child pornography is its own exception; pornography in general is not excepted.

            “Sexual images are a subset of all images, and were therefore included implicitly in the original.”

            To assert that a category is prohibited is to state that everything in the category is prohibited, not that a subset is prohibited.

            “Sending is not required.”

            It is required to be a member of the thousand cases identified.

          • Who wouldn't want to be Anonymous says:

            No, not “or”, “and”.

            English is incredibly imprecise and most writers, even well intentioned ones, are sloppy with the use of conjunctions. As a practical matter, in non-technical discourse it is almost always prudent to assume that “and” is used as a generic grammatical conjunction (as opposed to the logical conjunction) unless it is part of an unambiguous correlative construct. This is important because it is very often the case that the author doesn’t know, care, or want to break the flow with the verbosity necessary to make complex conjunctions unambiguous. And it is worth noting that the instant case is at least non-trivial. So don’t assume, consider the context. For example:

            1. The article is about a boy who has been charged for creating pictures of himself. Sending was not a factor.
            2. AFAICT, the laws usually create some combination of distinct crimes for creating, sending, possessing, and pandering.
            3. Because the crimes are usually distinct, creating does not necessarily require sending to be illegal. While it may seem unlikely for the police to discover the act of creation absent sending, it is not impossible. They may be investigating something completely different. I don’t know, maybe: “Ma’am, your son was seen at the scene of the crime taking pictures with his phone. We would very much like to see his phone so that we can use those pictures to put the sonofabitch that– — Oh, my. Those are certainly not the pictures we were looking for, buuuuut we’re going to be taking your son into custody now.”
            4. Because the crimes are usually distinct, sending does not necessarily require creation to be illegal. In fact, this seems like a very plausible circumstance. In fact, this seems like a very, very plausible thing for the police to become involved in. In fact, this is why everyone is in such a tither about teenagers sexting in the first place: the possibility that the person you send it to may send it to someone else. (While most of these cases probably involve an aggravating circumstance–doing it without the consent of the subject/creator–it is not required.)

            This is all well and good and supports the proposition that creating and sending are grammatically, not logically, conjuncted. But we can do one better. We can falsify the “logical conjunction” interpretation directly.

            If we assume that the construction as written is to be interpreted in a strictly logical way, then the “and” between “creating” and “sending” was intended as a logical conjunction. Therefore, all cases counted that do not involve both creating and sending necessarily involve an aggravating circumstance. But all cases are supposedly counted, and there exists at least one case that does not meet that criteria: the very raison d’etre of the article! [A more formal version of this is what I had in mind when I said your negation was inaccurate, and gave my corrected version.]

            No, the Supreme Court has explicitly stated that pornography is protected by the first amendment. What is excluded is obscenity. Child pornography is its own exception; pornography in general is not excepted.

            You and brad are, of course, correct. I was conflating the historic conception of pornography with the current definition of obscenity which both basically amount to “sexually explicit enough to be banned.” And as an amusing aside, I had forgotten that “I’ll know it when I see it” was actually the standard at one point; I was referring to the courts’ seemingly arbitrary and contradictory treatment of the subject. If you manage to get an appeal (as opposed to a trial court applying the standard), it is pretty much an utter crap shoot how the court will rule.

            To assert that a category is prohibited is to state that everything in the category is prohibited, not that a subset is prohibited.

            The assertion was that it is prohibited to take a picture and possess it. Generally, categorical assertions include universal qualifiers, but English sucks and sometimes writers use the singular where they mean the universal. While a categorical assertion is one interpretation, it is obviously false so perhaps not the most charitable.

            However, if it was a singular assertion, it is not obviously false and so probably more charitable. Since there is a non-empty subset of “all pictures” that are prohibited, there is at least one picture that is prohibited. So, as luck would have it, it is both more closely in line with what was written and turns out to be true.

            And you presumably meant “where” rather than “were”.

            I’m not a big fan of throwing those stones.

          • RCF says:

            “As a practical matter, in non-technical discourse it is almost always prudent to assume that “and” is used as a generic grammatical conjunction”

            I prefer to not assume. The point is that as far as what the article says is concerned, it’s “and”. If someone’s going to make claim X, then a cite for claim X should actually include claim X. Saying “well, they didn’t say claim X, but clearly they meant to say claim X” is unpersuasive.
            “We can falsify the “logical conjunction” interpretation directly.”
            My understanding is that “falsify” means “show false”, not “provide an argument for thinking is false”.
            “But all cases are supposedly counted, and there exists at least one case that does not meet that criteria: the very raison d’etre of the article!”

            You can’t have it both ways. You can’t claim that people are sloppy with language and their arguments can’t be expected to be rigorously logical, and then use the fact that under my interpretation the article was poorly constructed as evidence against my interpretation.

            “You and brad are, of course, correct.”

            I appreciate your willingness to admit that.
            “The assertion was that it is prohibited to take a picture and possess it. Generally, categorical assertions include universal qualifiers, but English sucks and sometimes writers use the singular where they mean the universal.”

            As I said, when dealing with prohibition, universal quantification is the only reasonable interpretation. For instance, reading “If you bring a gun to school, you will be expelled” as “There is a model of gun such that if you bring it to school, you will be expelled” would be understood by the vast majority of English speakers as disregarding the clear meaning.

            “While a categorical assertion is one interpretation, it is obviously false so perhaps not the most charitable.”

            While I see value in charity, bending over backwards to avoid any interpretation of another’s statement that leads to that statement being false is going too far. Also note that my initial response was “False as stated, and all reasonable interpretations that I can think of are also false, at least under US law.” I stand by that: any interpretation under which it is true is unreasonable.

            “However, if it was a singular assertion, it is not obviously false and so probably more charitable.”

            But that interpretation is both unreasonable and vacuous.
            “So, as luck would have it, it is both more closely in line with what was written and turns out to be true.”

            No, it is not in line with what was written. The only reason you are considering this interpretation is because you’re looking for a way for the statement to be true.
            “I’m not a big fan of throwing those stones.”

            I’m not “throwing stones”. It took me significant effort to figure out what you meant, and there are dialects in which the words are homophones and therefore subject to orthographic confusion.

      • Kaminiwa says:

        Wait, really? Minors are allowed to have possessions? Like, parents can be *arrested* for taking that picture away from the kid? o.o

        I was always under the impression that until you were 18, your legal right to property was basically held by your parents/guardians. The school bully can get in trouble for stealing from you, but your parents can’t.

        • Who wouldn't want to be Anonymous says:

          I’m not going to claim to be a subject matter expert, but yes. It the for the very reason that children can own property that their contract rights are curtailed–to prevent their property from being misappropriated because of their youth and inexperience. In general, they can enter into contracts and enforce those contracts against adults. However, most contracts are not enforceable against a them.

          Parents have responsibilities to manage a child’s property. These responsibilities include that of denying the child access to the property if doing so is in the best interests of the child. Taking a child’s phone away, for example, falls under this ambit. Using a child’s inheritance from a rich, long lost uncle to fund a cocaine infused caviar and champagne addiction probably wouldn’t. And the child could conceivable sue them for it. If their mismanagement or misappropriation was particularly egregious, there might be a possibility for criminal sanctions, but I don’t actually know. I suspect having parental rights curtailed and civil compensation are more likely avenues.

          As an insanely random historic example, consider George Washington. As you may recall, he married extremely well. Martha was a wealthy widower; her first husband having left his considerable estate in some division between Martha and their children. By marrying Martha, George not only gained control of her estate but also those of her children, whose property he became responsible for managing–and enjoying the income from until they reached majority.

          I am under the impression that what’s-his-name’s will had stipulations about what should be grown on the children’s land. For that reason, when George switched his (i.e., Martha’s) plantation from (IIRC) growing tobacco (which had to be consigned to an English merchant for sale in Europe) to cotton (which could be sold locally), he was unable to do the same for the property owned by the children. This distressed him greatly because he was unable to completely sever the company-store-like tie he had with his English agents. (Switching cash crops, by the way, is why GW was about the only Virginia plantation owner of that era to not die massively in debt to English merchants. This indebtedness, AFAICT, is an under reported stimulus to the revolution and the federalist/anti-federalist schism.)

        • ilzolende says:

          Fun fact: I don’t possess it if my parents want to take it.

          Somehow, if it’s illegal to possess a thing, then I become capable of possessing stuff. (If I decided to make an illegal image of myself and it was confiscated, the confiscator would also get in trouble, but that is a property of laws as applied to the image and not as applied to ownership.)

          Fun, yes?

          (I possess some capacity-to-decrypt-and-sign things, in that people can get rid of mine but they cannot take it for themselves, and I possess some intellectual property, in that destroying all instances of my online writing and art would be a big pain.)

          • Who wouldn't want to be Anonymous says:

            Step one: words are important. Possession and ownership are different things; e.g., theft is basically taking possession of property without the permission of the owner.

            Which are we talking about, because anybody can be denied possession if someone else wants to take it? The devil is in the ownership details.

    • James Torre says:

      Off Topic: Pursuant to, might I suggest the Greco-german chimera “eigenlexia” to denote “correct degree of reading ability”?

      • ilzolende says:

        I do not think the typical level of reading ability is the correct level of reading ability. My desire to continue asserting this is, in fact, my reason for wanting a word for the phenomenon.

        A faster version of hyperlexia is probably the correct level of reading ability.

      • arina says:

        Even more off topic: it is good to know that you are, like, alive! Did you build a UFAI? Also, can you get on fbchat or something?

      • Johannes says:

        “eigen” does not denote anything about “norm”, “correctness” or “standard” neither in the non-technical German nor in the notion of eigenvectors and eigenvalues from maths.

        I do not think one needs a word for this but “ortholexia” would be a better option (and avoid the mixing of language). But it might be to normative in connotation.

    • “ingroup members need to continue to exist in the future”

      I find this puzzling.

      We have been discussing two different approaches to curing autism. One is a pill, presumably a pill you have to keep taking, judging by current medication. People could decide to take it or not take it. Are you saying that you would want to deprive people of the opportunity to take such a pill in order to force them to remain the sort of people you want to interact with? That sounds like a hard position to defend.

      The other approach is genetic engineering, selective abortion, or something along those lines. With that, the choice is made by the parents, not the potentially autistic child. But that won’t reduce the number of autistic people who already exist. For simplicity, I will guess that you are twenty. If tomorrow someone came up with a perfect way of preventing autistic children from being born and everyone in the world adopted it, a rather unlikely scenario, you would continue to have just as many autistic people older than you, your own age, or up to twenty years younger than you to interact with. Is making sure that new autistic people keep coming into existence to be members of your ingroup of enormous importance to you? Is it a sort of in-group patriotism, where the point is not people for you to interact with but the existence of people like you who you probably will never interact with?

      Or is the point, as suggested by your “after I die” comment, that you think a world with autistic people in it is better than one without autistic people—even though many of those autistic people can be expected to be desperately unhappy themselves and to make other people close to them desperately unhappy? Is your assumption that if there are no autistic people there will be no creative, original, interesting people?

      I’ve known quite a lot of highly intelligent, highly creative, interesting people and, as far as I can tell, most of them were not autistic.

      I’m a pretty atypical person in lots of ways, but although I am in favor of a world with lots of different sorts of people, I don’t see that it is enormously important that people with my particular combination of odd traits continue to be born.

      • David Kinard says:

        It makes perfect sense from the standpoint of wanting to preserve one’s genes. I assume you want the human race to continue.

        • Given the descriptions here of the potential negative effects of autism, a pill that eliminated the symptoms would almost certainly increase the number of your genes that got passed down. That’s probably also true of genetic engineering or even selective abortion. A few of your genes get edited out, but the odds for the rest of your genes are greatly improved.

      • Anonymous says:

        “Is it a sort of in-group patriotism, where the point is not people for you to interact with but the existence of people like you who you probably will never interact with?”

        It seems to me that this is the same reasoning used to argue against bakers being able to refuse contracts to bake gay wedding cakes. I don’t think anyone actually thinks that this would prevent any gay couple from getting a cake. Rather the argument is that the existence of any bakeries which would not serve gay couples if they wanted them to – whether or not those gay couples ever need the services of these bakeries – is intrinsically upsetting.

  2. Two disconnected thoughts:

    Curing the violence, executive dysfunction and the sensory stuff seems superior to both “do nothing because if we get a cure it’ll be used coercively” (which it definitely will, though fake consensualism etc etc) and “cure that also treats intense interests and stimming and general nerdiness”. Finding an autism gene we could selectively abort for is probably the latter. I don’t think you’d make any enemies by saying “we need a cure for executive dysfunction!” No one really seems to know whether the good things and the bad ones are extricable.

    Also if a cure for homosexuality had existed a hundred years ago, it would almost certainly have alleviated the suffering of a lot of people. Today when you realized you were homosexual, you’d go get the cure and be all set. This isn’t an ironclad comeback, or even a comeback at all, just a thing I grapple with when thinking about the coercive potential of voluntary cures.

    • jooyous says:

      Yes! I have a related thought: I think autism rights people are (probably correctly) worried that the “cure” might just only consist of getting rid of the disturbing external stuff that neurotypical people find hard to deal with. So, imagine someone suffering from whatever it is that makes an autistic person scream and scratch their face off — but sedated enough to be sitting there quietly and being manageable. It becomes easy to say “look, we cured this guy! He is no longer clearly communicating that he’s suffering!”

      So I think in order to articulate Scott’s position, people need to very carefully talk about developing “a cure for the bad stuff” but also “methods to communicate with the person” to verify that the cure is what we think it is. The communication part is the trickiest issue about this because autism activists are probably closer to the experience of the non-verbal screaming people than neurotypical people, but like … not close enough to equate them. And then what happens to the current activists if we develop a babelfish and suddenly it turns out that all the non-verbal autistic people have been saying “no srsly, cure me!” all along? =/

      • Justin says:

        To be fair, the reason these people have this perception is entirely valid. Like, Autism Speaks released footage of a parent admitting her desire to kill both herself and her autistic child and it wasn’t done to condemn her, but to condemn autism.

        And inline with the subject of verifying meaning, being non-verbal does not mean non-communicative. Many non-verbal autistic people can communicate, given adequate accommodations.

        • jooyous says:

          Nono, I do get the non-verbal distinction! Like, I think a parent can learn to understand communication after living with their child, but there’s no nice flowchart that a caretaker at an institution could follow to try to interpret communication in a scalable way? (You know, kinda like that pain scale doctors use, which is kinda silly but at least it’s something?) Which, I don’t even know how you’d even develop that, but it’d get it suuuch a long way from where we are now.

          • Anonymous says:


          • Burninate says:

            My family lost some of this communication capability with my barely-verbal sister (vocabulary: maybe 100 words, applied sparsely in repetition for immediate wants, like “cookie” or “bathroom”) over the years since she went to live in a group home. Her intonations have drifted and now we don’t recognize as many of the sounds she’s making as words with the same ability as her regular caretakers.

          • David Kinard says:

            That pain scale is ridiculous. I have AS and am often in severe pain. But the standard of “worse pain you can possibly imagine” has everything to do with your capability of imagination. And people who experience more severe and chronic pain probably have a higher scale of what they could imagine then people who don’t. Plus the fact that people are biased to rate their experience compared to other experiences.

          • Marc Whipple says:

            Ditto on the pain scale. Some people have paltry imaginations.

            “The worst pain I can possibly imagine? Well, off the top of my head, I’m going to go with either having all my skin flayed off and then being dipped in a vat of rock salt and carpet tacks suspended in dilute hydrochloric acid, or having a stim machine attached directly to the pain center of my brain and turned up all the way. On that scale, this compound fracture of my leg is a 0.5.”

            This actually had what could have been serious but were mostly just funny consequences. I am used to pain: I have IBS. My pain scale is VERY high. One night many years ago I started having very bad pain in my chest. Eventually I went to the hospital and when asked about my pain, I said it was bad, but not that bad. Between that and my generally calm demeanor, they gave me a low priority.

            After a while it got bad again (it was coming in waves.) I had one of those rubber-barreled pens in my pocket and put it in my mouth to bite down on when the pain spiked. At one point a nurse came in, just as I dropped the pen. This is what happened:

            Me: I’m sorry, nurse, I dropped my pen. Could you pick it up and throw it away? I wouldn’t want anybody to trip on it.
            Nurse, seeing the pen: I won’t throw it away, that’s a good pen. *she goes to retrieve it*
            Me: You don’t want that, ma’am, it’s been in my mouth.
            Nurse: *picks up the pen and sees that I have bitten almost entirely through it* What on Earth?
            Me: I was biting it when the pain got bad.
            Nurse: *leaves the room at a very fast walk*

            Five minutes later I was being scanned. Apparently “bites clean through a pen while insisting they aren’t really in that much distress” is one of the secret Not a Seeker/Not a Hypochondriac/May Really Be Experiencing a Medical Emergency flags. (Did they teach you that one in med school, Scott? 🙂 )

            Nobody ever did figure out what the pain was: it went away after a few hours and has never returned.

          • Peter says:

            Those numerical pain scales are, well, a pain. I found a useful way to communicate is saying “I’d think about painkillers for this, but probably wouldn’t get around to taking them”, “definitely ibuprofen time”, “something with codeine in” and “time to ask the doctor for the good stuff”. I’ve never asked the doctor for the good stuff, but there have been a few times with freshly broken bones – or really bad toothache – where if a doctor was there, I’d have gone for it.

            But chewing through a pen I think just wins.

          • David Kinard says:

            Marc- Mine is more like-well, I understand that hypothetically it would be possible to engineer my brain to feel more pain while disabling my capability to cope with it. There’s no theoretical stopping point there. Furthermore, if we take out the limits of what seems physically possible, and imagine that some demon was able to torture us my making us experience all the pain, in all it’s varieties and nuances all at once, while changing my personality and very essence to experience this in the worst way possible and yet somehow it grows by infinite bounds every Planck unit…

            I guess, even though I am in severe pain, that would be a 0.0000000….

            Meanwhile, Person B walks into room…
            “I stubbed my toe. It’s about an 8 on the pain scale.”

          • David Kinard says:

            As far as AS goes- the pain varies a great deal. Sometimes it’s really, really bad. Other times, it’s not so bad, it’s just that it’s chronic and doesn’t go away. At very good times, it’s just a mild thing in the background.

            But the most painful thing I have experienced was definitely kidney stones. Man, that’s like, whole new level.

            By the way, the trick to the hospital thing is, call, don’t drive.

      • Alex Z says:

        Making people’s external symptoms more manageable would help caretakers a lot. That seems worthwhile.

      • Scott Alexander says:

        “Yes! I have a related thought: I think autism rights people are (probably correctly) worried that the ‘cure’ might just only consist of getting rid of the disturbing external stuff that neurotypical people find hard to deal with. So, imagine someone suffering from whatever it is that makes an autistic person scream and scratch their face off — but sedated enough to be sitting there quietly and being manageable.”

        That’s not the long-awaited “autism cure”. That’s Risperdal, which we use right now. Although admittedly I don’t know what autistic people on Risperdal’s internal experience is, and maybe they’re sedate internally as well.

        • Adam says:

          I know someone who’s brother has been on Risperdal and she stated that the medication wasn’t a great experience for anyone involved.

        • anon says:

          It’s definitely at the point on the scale where quantitative differences become qualitative differences, but I’ve been prescribed Resperidone (tiny doses, because my system is hypersensitive) to calm down my general sensory and emotional oversensitivity and help me manage my anxiety. I haven’t been diagnosed with anything in particular but I have a lot of the symptoms of autism-spectrum stuff, my psychiatrist is sure that my sensitivity to stimuli is at the root of my problems, and basically Intense World Syndrome describes my reality perfectly.
          Resperidone felt like a really nice break. Just a lovely rest from all the noise that my head is usually filled with.
          When I tried increasing the dose to see what it felt like, it was pretty awful and I felt robotic. But I imagine if my sensory overwhelm levels had been greater, like at non-functioning autistic levels, then the robotic feeling might also have been a lovely relief.

        • Michael Vassar says:

          I really would ask that you ask Anna Salamon what she thinks of Risperdal and autism, but maybe offer a trigger warning first.

        • Burninate says:

          From what I can tell, the effect of a steady regimen of antipsychotics on state of mind varies wildly from person to person and antipsychotic to antipsychotic and dosage level to dosage level. IMO if we treated them as full-on diagnostic trials, with high levels of observation and inquiry, we would achieve a lot better outcomes.

          My mother was released from a psych ward (‘mild psychosis’, BPD/bipolar-related symptom of nonstop PTSD-like reliving of every little thing that’s bothering her) with a brand new prescription granted on the last day, eliminating any semblance of validity to the examination of her mental stability on the two other medications she tried in the program; This is basically malpractice with these medications. She went through two months of *newly* suicidal near-catatonia before I eventually bullied her shrink into disbelieving her claims of being fine.

    • Airgap says:

      I don’t understand why it’s anything to grapple with. Why go to the trouble of teaching people to be tolerant of homosexuals if you can give them a dose of Homozine? Have you ever tried teaching kids to be tolerant of homosexuals? It’s the lamest and most sisyphean thing you can imagine. You hector the kids like a dork and pour your heart out and they stop calling each other faggots for an entire recess. I’ve never tried it myself, but I remember the sad sack homos who came to my school to raise our little consciousnesses, and even though I’d been raised to believe that gays were fine and all, I really wondered why they bothered.

      Presumably, after a course of Homozine, the former gays are now at least as happy being straight and loving the opposite sex as they would be being gay and loving the same sex, and that only if we remove all the prejudice from society (ha ha). And there’s every reason to believe that being gay makes you a little crazy even apart from the prejudice. Gay people are crazier than straight people, and this is roughly independent of the level of homophobia in society (look it up).

      • Vox Imperatoris says:

        Seriously, this is my reaction to all these sorts of questions.

        What if, instead of going through all the trials and tribulations of the Civil Rights Movement, they could have made a $5 pill to turn black people white? I sure as hell think a lot of black people would have taken that pill—and in the hypothetical world where such a pill existed, they ought to have been allowed to do so.

        Now, of course, even such a pill wouldn’t have “solved institutional racism”: blacks would still have been in a lower social class and could be identified through their mannerisms and family history. But I think many of them would have jumped at the chance to blend in on streets and buses.

        Sure, the “optimal” solution is to make white people tolerant of all races. But that’s really hard. And yes, the hypothetical black people who take the pill would, in the aggregate, likely make things worse for those who refused. But so what? In the last analysis, they don’t owe their lives to anyone but themselves.

        • Esquire says:

          This seems like a pretty easy bullet to bite… would you really want to deny this pill to those who want it? Why?

          It seems to me you’re just doubling down on “emotion over just multiplying” by recasting to an even more emotional object level.

        • Bugmaster says:

          I think the difference between the black/white pill and the autism/no-autism pill is that there are certain tasks that autistic people are physically unable to perform, regardless of any social pressures and lack thereof. By analogy, there are certain tasks blind people are unable to perform, regardless of how much our society cares for them. This is not the case with black people: the overwhelming majority of their problems are all social.

          • Airgap says:

            There are also certain tasks black people are physically unable to perform, like getting suntans. They’re not the most important tasks, but that’s not my fault.

          • Nero tol Scaeva says:

            Gym Assistant: “Hi! Welcome to Silver’s Gym! Can I help you?”

            Black Guy: “I’m looking to join. Can I look around?”

            GA: “Sure, I’ll give you a tour! Over here are the treadmills, we have about 30 machines with a variety of inclines and speeds”

            BG: “Cool, I like to go for a 5 mile run after work, though I think I’ll be coming here for a run when it starts snowing out”

            GA: “Over here are the free weights. Lot’s of space and mirrors to check your form; we also offer 6 months of personal trainer sessions with new members”

            BG: “Never been into weightlifting, but the personal trainer package sounds good!”

            GA: “Over here are the tanning beds. We have… I mean… uhh…”

            BG: “…uhhh….”

            GA: “…right… um, anyway, we also have our shake stand where we make a variety of shakes for members.”

            BG: “I like making my own shakes, but some of the shakes on your menu look good”

          • HeelBearCub says:

            “There are also certain tasks black people are physically unable to perform, like getting suntans.”

            That is, to use an old colloquialism, the weakest of weak-sauce arguments. If that is the best example you can come up with to refute @Bugmaster’s point…

          • Jaskologist says:

            I realize this is getting increasingly bogged down in minutia, but black people actually do tan.

          • HeelBearCub says:

            I actually thought about bringing that up, but decided a) that’s a forest and trees kind of thing and b) would simply allow the dodge of “that’s not actually tanning, just getting darker”

      • RCF says:

        “Gay people are crazier than straight people, and this is roughly independent of the level of homophobia in society (look it up).”

        So, the two primary hypotheses are

        (1) there actually are studies that show that gay people are crazier than straight people independently of the level of homophobia, and unlike every other study in the entirety of social science, these studies are completely reliable and irrefutable to the point that “these studies show this” can be used interchangeably with “this is true”, but for some reasons you’re leaving it as an exercise for the reader to determine what studies you are purporting to fulfill this role
        (2) You’re prejudiced against gay people, and your assertions regarding them are not reliable.

        Sorry, my prior leans heavily towards (2).

        Also, unless these studies show that maximum sanity level among gay people is lower than the minimum sanity level among straight people, the literal meaning of your statement is false; when dealing with such sensitive claims, you should word your statement more carefully, such as “Mental illness is more common among gay people.” Stating that every gay person is crazier than straight people, as the current wording of your post does, is offensive.

        I’m going to report this comment, because I would like some more clarity as to what the commenting standards are here. So far, Scott has communicated that calling someone a troll is completely okay, but posting blunt criticism of someone because they called you a troll constitutes completely unprovoked rudeness that is unacceptable. So I’d like to know where calling all gay people crazy falls.

        • keranih says:

          You could have simply said, “Cite, please,” and presented countering opinions.

          That a person is biased towards someone is of little help, if their data is still faulty.

          And following your edit – why on earth are you running to Scott with this? Because someone said something you found insulting? Correct the offender, make counter assertions backed up by evidence, and grow a thicker skin.

        • Anonymous says:

          “Stating that every gay person is crazier than straight people, as the current wording of your post does, is offensive.”

          I don’t think it’s clear that Airgap did state that; in my experience, statements about differences between groups are almost always referring to average differences rather than the kind of absolute difference you read it as.

        • Airgap says:

          I assumed we were all grown up enough around here to read “Gays are crazier than straights” the way you in fact assumed it should be read.

          I can’t pretend to be an expert on social science in this regard, but the studies I’ve seen either:

          1. Assume that increased craziness among gays is caused by prejudice, without referencing anything or showing any indication that they feel this point needs to be supported by evidence.

          2. Compare two or more societies based on the level of homophobia in those societies (by some metric), and find that the average increase in craziness can’t be explained by homophobia.

          There aren’t many of the type (2) studies (I recall one that compared, IIRC, the US, New Zealand, and the Netherlands). Probably because of what they tend to conclude. But there’s more than one. I’d ask if you knew of (2)-like studies which didn’t conclude this, but I’m guessing you don’t (go find some though; I’d be interested).

          I think it’s reasonable to treat “studies show X” as “X is the case” when all the studies show X.

          Finally, God hates fags. Repent, sinner!

        • David Kinard says:

          Um, I read that as being a criticism of Scott’s argument through aanalogy, i.e., you were supposed to interpret what the poster said as offensive, the point was to compare that with scott’s argument and say the same reasoning applies.

    • gbdub says:

      The “we would have gotten rid of homosexuality 100 years ago” thing is definitely not a comeback. Gay people, if left to their own devices, are perfectly capable of contributing to society as well as any other average human being. They require nobody to undertake a saintly life of tolerance and difficulty to care for all their daily needs.

      The same cannot be said of the severely autistic. This seems like a pretty clear distinction. Be as neuro-atypical as you want, as long as you aren’t unnecessarily obligating other people to care for you. If you’re a bit quirky and hard to communicate with, but happy that way, stay that way. If you’re violently lashing out at your caretakers and yourself, I think it’s fair to expect you to take the pill.

    • Tibor says:

      More generally, I think that any initiative to stop researching something can slow it down at best. If there is a demand for something to be researched and if it is physically possible to get the desired result (be it cure for autism, superhuman AI or a thermonuclear weapon) it will eventually be developed. If you are worried about a technology being misused a better strategy is to come with something that could counter it or refine it in a way that the misuse or dangers of it are diminished rather than to try to prevent the discovery from happening. This is especially true if you are worried about the bad guys having it. If the US had decided not to develop nuclear weapons because they are dangerous, the Soviets would have and ve vould all be comrades nau, yes? If you are worried about cure for autism targeting “the stuff people with normal neurology find annoying about autism” rather than the actual problems of autists, then a good response is to try to come up with a better cure.

      A friend of mine did some research on tracking down the TOR network as a part of his Ms. thesis. When he started he was not sure he wanted to do it. It was very interesting but also something that can be abused by the intelligence service (while there is a lot of actually nasty stuff going on on TOR, it is a good thing to have something no state can easily monitor, I think the good outweighs the bad here significantly). I told him that it is better to come with the way to beak the safety of TOR first and publish it for everyone to see (and possibly fix) than not to do it, because someone will do it anyway, perhaps has already done so and decided to keep that for himself (or more likely themselves) instead of exposing it to others…I know that this last thing is not very related to the medical research since if you are not an anti-vac conspiracy theorist, it does not seem likely that one could administer drugs to people in secrecy without being found out. But generally, I think it holds true that trying to keep something unknown for ethical reason does not work so it is best to make it known to all as opposed to wait for someone to make the discovery in secrecy and potentially use it against others.

  3. Acedia says:

    I’m autistic and I want a cure. This social movement is baffling to me, and until I read this blog entry I was under the impression it was only a few tumblr weirdos that supported it. How horrifying.

    e: And just so there’s no confusion: the vast majority of the suffering I experience due to autism is directly caused by the autism itself, not mistreatment by others. People being nicer to me wouldn’t fix shit.

    • Wrong Species says:

      I can’t say whether I’m autistic or not. One of my family members is so I probably have some “austistic genes”. But if there was a cure for nerdiness I would take that in a hearbeat. It’s difficult to enjoy the advantages of being unique when suffering from crippling depression.

      • Daniel says:

        Why a cure for nerdiness rather than the depression? Is the depression entirely caused by you being nerdy?

        • Wrong Species says:

          Ideally I could be happy without such drastic measures but I was assuming that the choice was either the status quo or becoming normal.

          • Tibor says:

            I dunno what “normal” means. Being a maths PhD student and interacting with other mathematicians or similarly “attuned” people most of my time, I consider that to be “normal” even though it is quite surely not very representative.

            As long your personality is not causing you harm by itself (being suicidal for no external reason for example), you can always find enough people like you to get along with. You end up living in a bubble of sort, but who cares really? As long as you are not always into the most popular thing, you will live in a bubble anyway. Of course, this is harder to do this if you are a schoolkid and have get along with everyone else. But it gets better as you get older, at least it did for me. I always wondered why the people in the films are always nostalgic about their high school days. For me, the worst time was between the ages of say 12 and 19, then it’s progressively gotten better. Now I’m 26, so maybe when I’m 50 my memory will also be covered by a layer of nostalgia thick enough to obscure reality, but I think the reason you see this in films is rather that in fact most people do enjoy their high school days.

            Of course, if your depression is caused by something internal then it is an entirely different story.

    • chaosmage says:

      There are even deaf people who want to stop parents of deaf children from getting them cochlea implants. Horrifying? I’d call it a curious extreme of how hard it is to reason about what one identifies with. Maybe that’s more true of group identities that want to recruit members in order to perpetuate themselves.

      • CAE_Jones says:

        Anecdotally… things like how frustrating capitalism is for blindness-related tech, and how occasionally something will come across as both incredibly mainstream and incredibly opposed to the idea of believing I and things I want can exist… occasionally forces me to remind myself that becoming a supervillain who goes around shooting out the eyes of millions of people would be a very bad thing. (Note: this is very recent and did not happen before I was living alone and out of school and I don’t think it’s a good idea, just that an extra million normal people suddenly going blind might make the market slightly more favorable.)

        Being alone, disabled, akratic, and depressed, I’ve had plenty of time to imagine a variety of miracle scenarios. I keep coming across the conflict where “If this is a world-wide miracle, everyone who wants to be cured of vision loss should be cured… but does that mean that even more people will ignore all the cool innovations I want this miracle world to have?”

        But I don’t see blindness as essential to my identity or anything. I would be kinda terrified to get perfect vision, but getting back what I had in the 1990s? Yes please! And none of my imaginary friends are visually impaired, unless it’s one of the timelines where I go back in time in a new body to make past me be less of a useless idiot.

        Personality-wise, though… I don’t think I fall on the autism spectrum, and there are more straightforward explanations for my idiosyncracies, and I don’t think I even have Scott-level sensory issues (unless you count a very learned hatred for smoke), yet I’ve had people believe it plausible enough to seek a diagnosis (back when Aspergers was a thing). I find myself more likely to stick around online communities where a rather higher-than-baseline number of people claim to be some degree of autistic. I can see the argument from “but if they cure autism, there will be fewer people I can relate to, and there are so few as it is!”, mostly because I kinda worry about the same thing. But, of course, I don’t have much experience with people with the more severe symptoms, and if we can separate personality from the suffering-inducing symptoms, I’d probably go for that, ceterus paribus.

  4. I have the first comment? This has never happened. (Of course, by the time I post this I’m sure I’ll no longer be first.)

    Anyway, by the broad definition, I’m autistic. I even make flappy hand movements. It’s… actually kind of terrible, because my particular compulsion involves moving my fingers in a way which causes joint pain after a while, and if I do it where people can see me I get very strange looks.

    I would be deeply opposed to a cure for autism of my sort, since, as discussed above, it’s very hard to disentangle this kind of “autism” from general nerdiness, and the very mild suffering associated with this is mostly under my control. (I can be aware of my surroundings and adopt a completely neurotypical behavior when I need to.) But then, I don’t call myself autistic. I get extremely annoyed with people who are approximately like me who call themselves autistic, because I feel like many of them are just making excuses for themselves.

    My son is actually autistic, in that he has an actual diagnosis from the school system’s psychiatrist.

    At the age of four, when we finally took him to a psychiatrist, he had a vocabulary of ~20 words, and he would regularly scream, beat his head against the walls, and claw at his cheeks until he drew blood when he was upset. The pediatric psychiatrist we talked to suggested that his biggest problem was mere frustration at being unable to communicate. At her suggestion, we enrolled him in a mainstream preschool (though we had a hard time finding one that would take him in that condition) and got him a speech therapist. He acquired a much larger vocabulary working with the speech therapist, which made his self-harming go away almost immediately, and he did very well in a structure preschool setting. This turned out to be a major motif: he thrives under structure and routine, and it almost doesn’t matter what he does, so long as he knows every day what his day will be like.

    Now he’s seven, and he’s enrolled in a normal kindergarten. He still doesn’t have anything like the language skills of a normal seven year old, but he can make himself understood. He still has screaming fits, but they can be controlled, and he’s learning to self-control. I don’t know if he really has any friends, but he knows how to say hello/goodbye to his classmates, and he plays nicely with them on the playground.

    This is a mild case. I would still cure it in a heartbeat if I could.

    • Randy M says:

      Not sure how exactly to phrase this, but after a generally saddening article, I am gladdened on your behalf reading about your child’s progress.

      • Nathan says:

        Similar: my brother is pretty damn autistic. As a kid he was pretty violent (fortunately he was also quite small, but damn he bit hard) and he remained nonverbal for a long time, well into his mid teens. Now he is still randomly loud and noisy, but he is completely non violent. His speech is badly slurred and abstract conversation isnt happening, but he can speak and write to a rudimentary level and his comprehension outstrips his communication significantly. Most amazingly, he actually gets on a bus on his own and goes to his job that he works at! Which is pretty incredible to me given that for basically my entire pre-adulthood I was never able to imagine that I would be able to ask him to pass the salt.

    • ozymandias says:

      If it helps: a lot of the autistic self-advocates who don’t want to be cured *were* like your child when they were seven. (I am friends of friends with a couple of people who work at ASAN, and… yeah.) So even if you would take a cure in a heartbeat now, there’s a moderate chance your child will grow up to be happy enough in his autism that he doesn’t want to be cured either.

      • keranih says:

        there’s a moderate chance your child will grow up to be happy enough

        Is there a number attached to ‘moderate’? 90%+ of my knowledge here comes from news reports, and within the last two weeks I read/heard that 10-20% of autistic kids (diagnosed around 2 years old) would – with therapy and drugs – get cleared of the condition to the point of no longer registering on the spectrum.

        …and thinking about it, that number would probably be a function of what line we used to define ‘autistic’.

        • ozymandias says:

          That’s called “optimal outcome”. It’s confusing, because it is unclear what percent of them are happily NT, what percent of them are desperately unhappy but capable of passing, and what percent of them are going to burn out age 20.

          Also, not what I was talking about. The ASAN people are mostly not optimal-outcome, they’re mostly people who still have autism and want to continue to have autism. I am not sure why everyone has such difficulty on this point.

          • keranih says:

            I am not sure why everyone has such difficulty on this point.

            Not sure either, but it does appear that many people are struggling with it. If you’ve got the code cracked, please to grant mercy and charity on us lesser mortals, until we catch up.

            they’re mostly people who still have autism and want to continue to have autism.

            …okay. So long as there was not a requirement on me to change my life to support them, and so long as their lifechoice did not require additional burdens on me, I see absolutely no reason for me to insist they choose to live in a way that they didn’t prefer. In fact, failing an impact on me, I am not sure that I should have much voice at all(*) on how they lived their lives.

            Did their choice impact me, that would be different, and I would expect a larger input as the impact increased.

            (*) Always excepting my god-given right as a free ‘Merikan to put in my two cents about anything and everything.

      • gbdub says:

        But are those members of ASAN still like Mai La Dreapta’s child? Because a lot of adults with autism are. I think the struggle is that you need to define what “still has autism” means. Are they totally noncommunicative (clearly not)? Do they still engage in serious self-harm? Do they live totally or mostly independently?

        It’s one thing to say “I still want to be autistic” after you’re already learned techniques and found accomodations to take the harshest edges off. It’s quite another to force a non-communicative, self-harming child to suffer that way for a few years on the chance that 20 years from now they can look back on it as a character/identity building experience (not to mention forcing the child’s parent’s to take on that burden as well).

    • coffeespoons says:

      I am probably on the less nerdy end of the rationality-sphere, but I tend to be attracted to nerdy guys/guys who might fit in to the wider definition of autistic. I am slightly worried that if I have kids with a nerdy guy there will be be a higher chance of me having a low functioning autistic child.

      • Marc Whipple says:

        You should be more than slightly worried.

        You should not be terrified, but you should definitely be more than slightly worried.

        • keranih says:

          @ Marc –

          What, in your opinion, would be reasonable steps for a nerdy person, who anticipated having kids with another nerdy person, to take to prepare for the possibility of an autistic child?

          • Marc Whipple says:

            Another commenter said something about new genetic tests – whether what they said was right or not, I’d look into that.

            After that? Nothing can prepare you, especially since there’s no way to know where on the spectrum a child might lie. The only suggestion I have is to read some books for parents of autistic children and by/about parents of autistic children. Although I haven’t read all of it, my wife contributed to this one:


            So I know there’s at least one good section in it.

            Do not read Temple Grandin’s books. Save those for if and when – may it never come to pass – you need some hope.

            Otherwise, evaluate your life. Can you commit to supporting such a child? This has legal, financial, and long-term physical implications. Do you have your own health problems, mental or otherwise, which would be aggravated by or prevent you from caring for a special-needs child? How old are you?

            I could go on for a long time: not only am I naturally long-winded, I’m a lawyer, and thinking about all the ways something could go wrong is what we do. If you’d like to discuss this via email or Skype, I would be pleased to be of service. But short of writing my own long blog article, I don’t know how much more in-depth I should go at this point.

            PLEASE NOTE: I’m not saying you shouldn’t have children for fear they’ll be autistic, not without a LOT more information. I’m not saying you shouldn’t want to have children, dream of it, have lovely imaginings about how much you’d like to have some. They are pretty amazing. Even autistic children. As I’ve said, my daughter is an amazing kid and I love her to bits.

            But depending on how you and your hypothetical mate actually end up, it would make sense to consider the possibility and use it to guide your decision, as well as thinking about long-term life goals it might affect.

          • Advesperacit says:

            There is some research on pre- and periconceptional factors that may affect the likelihood of autism in children. These include paternal age (higher is riskier), vitamin D status, folate status, and choline nutrition (only in mouse models for choline though, I think). Scott and others are doubtless better qualified than I to evaluate how robust the evidence is for these, but taking some supplements and having some extra sun exposure before and during pregnancy seems to me to fall under “unlikely to hurt, doesn’t cost much, could very well help” (assuming of course you don’t take unsafe doses, which nobody would study in pregnant women anyway, right?).

          • Andrew G. says:

            Paternal age as a risk factor for autism has been previously discussed by our host here.

    • Airgap says:

      I commented before you, but the system went all funny on me.

  5. TrivialGravitas says:

    Doesn’t “stop treating autism as a disease” essentially amount to “throw autistic people into the street” within the context of US law?

    If you’re not sick there’s no job skill training (not exactly useful really as one of the 76% unemployed high IQ autistic people, but I did manage to have a job for 2 years), no disability welfare, and in most states no health insurance.

    How the hell is this coming from people who say they’re for autism rights? Are they just so utterly clueless about the issues adult autistics face?

    • Justin says:

      No, it doesn’t. You can treat something as a disability, which autistic people absolutely endorse, without treating it as a disease. Disability support doesn’t require is recipients to be diseased, but rather to be disabled. Autistic people are disabled, they are not diseased.

      • CatCube says:

        I’m going to need that distinction explained to me. I don’t see why one way of supporting a “disability” is to make it disappear or vastly minimize its effects–e.g., a prosthetic leg.

        • Justin says:

          A prosthetic leg doesn’t make the disability of being short a leg disappear. A person with a prosthetic leg is still profoundly disabled.

          Vastly minimizing the negative effects of autism is exactly what autistic self-advocates want, it’s just that, using the social model of disability, they see the negative effects not being the manifestations of their autism, but rather how others respond to them. A “cure” model seeks to removes their autistic traits rather than accommodate for them. It’s like putting all the money into curing congenital blindness at the expense of publishing works in braille.

          • DrBeat says:

            One: Do we actually know it’s at the expense of Braille publishing? Because that’s never the objection I see; they don’t say “you shouldn’t take away money from X to cure Y”, they say “Y should not be cured at all”.

            And taking all the money away from curing congenital blindness in order to publish books in Braille seems just as, if not slightly more, wrongheaded.

            Two: A good enough prosthetic, in theory, would very much make the disability of being short a leg disappear. We are attempting to develop those prosthetics right now. Is that a bad thing?

          • ozymandias says:

            Given a fixed amount of money for autism research, researching cures is at the cost of researching other things.

          • DrBeat says:

            So then you’re saying “Don’t put any money to research how to cure blindness, put it all into printing books in Braille”.

            Which… seems like a self-evidently horrible idea, for all the reasons laid out in this post.

          • Justin says:

            No one is arguing that absolutely all of funding aimed at finding a cure should be redirected, just that the model, as it stands, is backwards. I always find it a bit amusing how in these types of discussions it ends up being me complaining about (presumably?) neurotypical people engaging in black and white thinking.

            Prosthetics are absolutely not a bad thing, but the analogy fails. What would this theoretical prosthetic look like in terms of autism? A technological solution to problems which a technological solution could solve would be absolutely welcomed by autistic people, but most autistic traits can’t be transhumanismed away.

          • Nathan says:

            @ Ozy, “Given a fixed amount of money for autism research” seems like a hell of an assumption.

          • Murphy says:


            But that’s the thing. Some people *are* saying that absolutely all of funding aimed at finding a cure should be redirected.

          • Scott Alexander says:

            “No one is arguing that absolutely all of funding aimed at finding a cure should be redirected”

            Autism cure researchers have been accused of genocide and received death threats. I think there are definitely people saying that all money going to a cure should be redirected.

            I also think the “people only spend money on cures, not on existing people” thing is exaggerated. The US spends between $10 billion and $50 billion (depending on method of calculation) supporting autistic people. I bet they don’t spend a fraction of that much on cure research.

          • Howie says:

            @Scott Alexander: The Government Accountability tried to break federal autism research into categories here ( I can’t verify that it’s perfect but GAO reports of this kind are usually well respected. The breakdown of (nominal) federal research over the period 2008-2012 spending follows.

            Biology – 314 (28%)
            Treatments and interventions – 237 (21%)
            causes – 235 (21%)
            Diagnosis – 145 (13%)
            Infrastructure and surveillance – 118 (11%)
            Services – 37 (3%)
            Lifespan issues – 19 (2%)

            Those categories are of course pretty broad and it’s hard to say, for example, whether everything in the “treatments and interventions” category is really cure/disease oriented. But this is the context in which the Autistic Rights Movement pushes back around disease/cure rhetoric. Their perception, at least, is that the “services” category is the type of research most likely to make their adult lives better without changing their identity. And they are calling for an end to research towards a cure, in part, because the funding system that is currently looking for a cure seems to be funding that research to the exclusion of other efforts.

            See ASAN’s press release on this issue here:

            Note that I don’t have a first-hand take on whether it’s true that research on services is the main category of research that would accomplish the Autism Right’s Movement’s goals.

          • gbdub says:

            @Howie – that’s all “research” though. We spend way more than that on actual supportive care.

            And is there really a big federal bucket marked “autism” and any cure research excludes support research? Or is it that there’s a bigger federal bucket marked “medical research” and there just aren’t enough people writing compelling proposals for autism support?

            And how much money is going into general “supportive care” research for mental health, the elderly, etc? Much of that could be cross-applicable to autism. Whereas the cross-applicability of schizophrenia cure research to autism cures is probably much smaller.

            In any case, it’s certainly possible to advocate for support research without demonizing cure research, but that doesn’t seem to be the selected tactic.

          • David Kinard says:

            This made me think that perhaps to get more attention paid to Ankylosing Spondylitis I should come up with some ridiculous thing that some AS people don’t want to be cured, and have controversial articles be published. Think of all those angry right wingers who will be screaming to fund AS research! (By the way, in case you are wondering, I have never, ever, ever come across anyone with AS who didn’t want to be cured. A lifetime of severe pain and progressive loss of mobility make that issue pretty cleat.)

            It also makes me think of a horrible, horrible joke.

            “Grandpa, do you want your Alzheimer’s cured?”
            “Do you want your Alzheimer’s cured?”
            “No I don’t want any.”
            “Ok then, he says he doesn’t want it.”
            (Caretaker leaves the room, closes the door.)
            Grandpa: “Eh, I changed my mind, I would actually like some tuna salad.”

      • TrivialGravitas says:

        By that definition of disease it has never been treated as a disease by anybody ever. It is afterall not infectious.

        • Justin says:

          Well, that’s a large part of the point these people are trying to make.

          • TrivialGravitas says:

            No it isn’t, they’re saying it isn’t something to be cured.

            To take the missing leg thing from the other branch, while a prosthetic leg is imperfect that’s on us. If we had the ability to make legs grow back like lizards do we would use that technology.

          • Randy M says:

            To be less hypothetical, there is (or so I’ve read) debate between deaf people about whether deaf people should be cured. As far as I know, it is pretty analogous to this, minus the broad variation in symptoms.

          • Justin says:

            Yes, it isn’t something to be cured, but it also isn’t a disease, just the way there isn’t an “epidemic”. Linguistics affects how people see things. Perhaps autistic people doubly so.

            And yes, autism self-advocacy owes a lot to the Deaf community (to use their preferred terminology). The leading autism self-advocacy group namedrops the National Association of the Deaf. The notion of “nothing about us without us” is shared across disability self-advocates.

          • TrivialGravitas says:

            If it is not something to be cured, you don’t get government assistance. That’s how the real world works.

          • Justin says:

            That’s both not how the real world works (there’s so much government funding for accommodating for incurable disabilities) and the problem with how people think the real world works.

          • TrivialGravitas says:

            There is money for accommodating incurable disabilities that we would cure if we had the option. There is not money for anything we think of as just being diverse.

          • Justin says:

            Okay, but I’m not arguing that it should be seen as “just being diverse”. Neurodiversity is an example of a form of diversity, but autism is an example of a form of disability.

            And there is lots of money and accommodations for incurable disabilities that are inherently incurable. You still get funding out of disability budgets if, say, your legs get chopped off in a freak accident and you need a wheelchair.

          • Anonymous says:

            Linguistics affects how people see things

            If you read any book about linguistics you will find out that it actually doesn’t.

          • Richard Gadsden says:

            And there is lots of money and accommodations for incurable disabilities that are inherently incurable. You still get funding out of disability budgets if, say, your legs get chopped off in a freak accident and you need a wheelchair.

            That’s not inherently incurable, we just don’t know how to regrow legs yet. I’m not convinced there is such a thing as an inherently incurable disability.

            The core argument of the social model of disability for autism is that the disability isn’t the autism, it’s the way a society mostly composed of allistic people treats autistic people.

            I suspect that, for the sort of autistic people who are active self-advocates in organisations such as ASAN, that’s largely true, and, for the sort of people that Scott describes, it largely isn’t.

          • Justin says:

            Keeping in mind that autism is a genetic trait that is triggered at some point before birth, what specific indications are there that the sort of people Scott describes, who are actually relatively rare among autistic people, would not benefit more from being extended adequate accommodations that compensate for their disability than from whatever the alternative is?

          • Murphy says:

            This is one of those stupid things where the “Campaign for equal heights” types take issue with the word “disease” where they make up a load of meanings for the word then insist that using it is wrong. The same thing is happening with dementia.

            It is no longer acceptable to say that someone “has” or “is suffering from” dementia or Alzheimer’s disease. Apparently the Acceptable phrasing is now “On their dementia journey”.

            No, I am not kidding.

            near future news: You can no longer refer to someone as having “had a stroke” they’re now to be referred to as “on their partial paralysis safari”.

          • Justin says:

            No, if there’s anything this is indicative of, it’s an autistic level of pedantry. It’s not that disease is being redefined to exclude autism, it’s that the existing definition doesn’t include it.

            You might be pleased to note, however, that autistic people often frown on awkward linguistic supposedly politically correct constructions like “person with autism” or “person with a disability” for another whole host of pedantic reasons.

          • Murphy says:

            No, it seems to fit quite well within the real dictionary definition of the word disease in the same way that Sickle-cell disease does.

            “An abnormal condition of a part, organ, or system of an organism resulting from various causes, such as infection, inflammation, environmental factors, or genetic defect, and characterized by an identifiable group of signs, symptoms, or both.”

            Some advantages, some disadvantages. Likely genetic. Not contagious. Perfectly fits.

            Trying to insist it’s not a “disease” is no less silly than insisting that alzheimer’s disease isn’t a real disease and insisting on calling it a dementia journey.

            To head things off at the pass: I’m perfectly happy with the idea that not all diseases need curing in all cases.

            If you have Sickle-cell disease but live somewhere with malaria it may even by extremely sensible to refuse a cure and if you just don’t want to be cured of a non-contagious disease for any other reason I’m fine with that too.

          • Nicholas Carter says:

            The definition Murphy has provided for disease does not exclude a car accident as an environmental effect, and as it seems absurd to define being hit by a car as a disease, I contest his definition.
            Also, I think a more straightforward case is contra racism: The right answer to racism was not making black people white. So the right answer to ableism is not ending disability.

          • Science says:

            Re: government assistance and curability

            Would someone with severe but entirely correctable myopia be entitled to SSI, Medicaid, etc if she wouldn’t wear glass / contacts / get the surgery?

            Where does myopia fall on disease / disability dichotomy?

          • Murphy says:

            >Nicholas Carter

            “environmental factors” don’t usually get stretched to include things like being stabbed even if the stabber was in your environment when they stabbed you.

            The right answer paralyzed children in iron lungs wasn’t to make sure they had really really comfy iron lungs and lots of non-stigmatized social interaction while locked in them.

            Some people might be quite happy but taking the choice away from the other individuals isn’t the answer.

        • Deiseach says:

          Obesity Epidemic, TrivialGravitas! I got lectured up one side and down the other on here when I commented about finding this term offensive, as everyone and his cat ticked me off for “Of course it doesn’t mean fat people are infectious and you can catch being fat off them!”

          If obesity can be an epidemic without that meaning it’s a disease, so can autism 🙂

        • magnetick says:

          I think the word you’re looking for here is “pathology.” Like how menstruation causes me occasional distress, but it’s not pathological and doesn’t need to be cured. A lot of people do take a pill to prevent menstruation, but we don’t say they’ve been cured of menstruation.

          It’s easy to medicalize these processes because we can point to their biological basis, but the tricky next step is deciding whether or not the process is benign or pathological. The menstruation example is a good one, since it can end up working out really badly (e.g. endometriosis, which is generally considered pathological) or we can chalk some effects up to “shit happens, but it’s normal.”

  6. Grant says:

    Let me begin by saying, thanks for writing this post. I have had many similar thoughts on autism. This is a topic almost as strife causing as gender. I volunteer at my church with teenagers and young adults with autism. The spectrum ranges from the high functioning kid who, stereo-typically, tells me every single fact about dinosaurs and trains to a non-verbal teenager who carries around a barney doll and jump rope while gnawing on his hand and making guttural noises. The autism-is not-a-disease crowd seems to be a giant F-you to the mother of the kid that carries a barney doll all day, gnaws on his hand, and yells randomly.The source of conflict appears to be around people equivocating between difficult experiences and then getting offended when someone tries to say their experience is not difficult. People compare their situations to others and get offended when they perceive someone else in a situation they deem less difficult and that person says no its just as difficult. The focus should be less on comparing one’s problems to the problems of others and realize that some people will always have it worse while others will always have it easier.

    • ozymandias says:

      Being nonverbal, self-injuring, and yelling all the time certainly seem bad, but I’m not sure what’s wrong with carrying around a Barney doll. I have to say, a cure for the desire to carry around a Barney doll seems significantly lower priority than a cure for earwax.

      • Randy M says:

        Well, it may be a sign of anxiety or some other underlying issue. Sometimes children attach to certain objects for a phase to cope with some fear, etc. which passes with time, and while there’s little harm in having the ‘crutch’ it’s preferable that it passes.
        Of course if preferring children’s toys is simply an affectation, fine, but that’s not what I’d assume given everything else.

        • Justin says:

          Autistic people often tend to have that kind of attachment even without that kind of underlying coping mechanism, though. Like, that’s definitely a thing.

          • Randy M says:

            And if they couldn’t find it, would they still be able to go about their day otherwise? If they had the opportunity for something they enjoy, could they set it down for a time? If so, then I’d agree it’s not a problem, but if not, then, speaking for myself, it’s something I’d like to overcome (all other things being equal) even if I, right now, liked whatever object it is.

            (Note: all my posts are largely speaking from ignorance on this subject.)

          • Justin says:

            It may be something you’d like to overcome and that may be entirely valid, but if you’re coming at it from a place of thinking the attachment is borne out of fear, whatever therapies used to achieve it would likely fail because they’d be misguided.

            Autistic people often do reach a point where they can suppress or hide their autistic traits, but that’s not necessarily a positive outcome. Being able to live without that kind of attachment to an object (for example) is positive just for the sake of being able to go day to day without needing that specific object to function, but replacing it instead with deep shame over autistic traits is much more destructive in the long term than accommodating for them.

            I’m speaking about this from far too much intimately personal knowledge on this subject.

      • Justin says:

        I’d argue there isn’t anything wrong with being non-verbal or yelling all the time, either, it’s just that, like carrying around a Barney doll (or liking train schedules or whatever) they’re things perceived as out of the ordinary and most people just want to squash that which is out of the ordinary.

        • Randy M says:

          Really? How so?
          (I’m interpreting yelling all the time in light of some of the things Scott mentioned, ie, random screaming at frequent intervals. If you just mean being a “loud talker” but otherwise intelligible and able to restrain from speaking when needed, nevermind).

        • ozymandias says:

          Being nonverbal makes communication far more difficult, and yelling all the time is unpleasant for others who are around you.

          • Justin says:

            Unless we’re operating under wildly different meanings of the idea of wrongness, I don’t see how either of those things rise to the level of being wrong. Difficult and unpleasant perhaps, but wrong?

            And really, there’s enough darkness in the history of squashing things in the name of preventing unpleasantness for others that I think it’s high time to reconsider it as being especially important.

          • Murphy says:


            A child comes in with their leg bent 90 degrees half way between their knee and their ankle and their arm similar half way between wrist and elbow.

            A doctor says “There’s something wrong here” and you leap into action:

            “I don’t see how either of those things rise to the level of being wrong. Difficult and unpleasant perhaps, but wrong?

            And really, there’s enough darkness in the history of squashing things in the name of preventing unpleasantness for others that I think it’s high time to reconsider it as being especially important.”

            And so the doctor doesn’t set any bones for fear of squashing differences or questioning the moral character of the kid with the broken limbs.

            You’re equivocating and you know it.

            It’s not a reference to “wrong”[moral] in any way.

          • Justin says:

            I said nothing about morals.

            There is something objectively physically wrong with someone whose bones are broken and whose limbs are bent out of shape that requires medical or surgical intervention. There isn’t anything objectively physically wrong with someone who yells a lot any more than there is something objectively physically wrong with someone who carries a Barney doll around with them. There’s something subjectively socially wrong with them and they’re acting abnormally, but socialization and normality are relative. Intervention for abnormal socialization opens up the gate at the top of a very slippery slope.

          • Murphy says:


            I see you’re ignoring the bits that don’t feel right to include in your argument like the self-injuring. If someone is chewing their own skin off there’s something wrong. If someone gets stuck at the developmental level of a small child or is failing to understand and manage social interactions there’s something going wrong.

            Nothing is morally wrong in any case but something is *going wrong* just as much as with the broken bones.

            Lets talk about a different issue. Lesch nyhan syndrome. Only look at the image if you’re not easily horrified. ( ) Children with lesch nyhan syndrome tend to eat their own faces and chew off their own fingers as well as having various learning difficulties.

            In your opinion is there anything wrong with this using the same meaning of the word “wrong” that you’re using?

            Would the world be a better place if we had a cure for it or a pill we could give the kids so that they never developed the problem?

            We know the cause, a simple SNP.

            I just want to be clear whether you’re just drawing a line around one group whom it’s popular to draw a line around as special or is it a general rule you’re following.

          • Justin says:

            I think you misunderstand me. I was talking about a specific autistic trait that was explicitly mentioned and you’re talking about different ones and now talking about another condition altogether. I wasn’t applying what I was saying to all traits of autism, let alone to any other conditions. I’m not drawing a line around a group, I’m drawing a line around a specific behaviour. I apologize for not being more clear.

          • Murphy says:

            Ok, fair enough. In that case Re, nonverbal and in broader terms non-communicative I think my only problem with it is that if you have someone who can’t communicate clearly then that introduces a massive problem of them not being able to tell you if they’re in distress which may lay some kind of moral imperative to get to the point where people can communicate clearly if they wish to such that the person actually has a choice.

            If someone is able to communicate but chooses not to then it may be difficult and perhaps unpleasant but isn’t wrong even in the non-moral sense.

            Though that brings up another sort of moral problem if the inability to communicate is due to something in the mental architecture central to who the person is such that changing them enough to allow communication might be destroying part of them so even if the person thanks you afterwards you might not be morally in the clear….

          • RCF says:

            The phrase “there’s nothing wrong with X” is an idiom. It is simply not valid to analyze the claim “there’s nothing wrong with X” by examining the meaning of the word “wrong” and seeing whether it applies to X, and trying to do so either betrays a lack of understanding of the English language, or deliberate exploitation of idiomatic language.

          • Randy M says:

            Just because something is an idiom doesn’t mean it is devoid of content attempting to persuade.
            It seemed to me Justin was saying that, basically, social norms around communication are arbitrary and/or detrimental to autistic people moreso than their inability to comply with them are.

            I think that norms against yelling randomly are quite sensible and decrease the stress of others, enable more efficient communication, prevent genuine cries of alarm from going unheeded, etc., and therefore there is a net problem with a compulsion to do so. No?

        • CatCube says:

          OK, I agree that there’s “nothing wrong” with being non-verbal, so long as what you mean by “wrong” is “moral failing,” but if you mean by “nothing wrong” that we shouldn’t find a way to make somebody able to communicate if it’s within our power to do so, then we’re so far apart I don’t know that we can have anything approaching a productive conversation.

          • Justin says:

            Accommodations should absolutely be provided for making communication easier for those who have difficulty communicating. I’d argue that such accommodations should be legally mandated in certain contexts the way accommodations for physical disabilities are. It’s the methods of getting to that point that are what I worry about.

          • HlynkaCG says:

            This +100.

        • ozymandias says:

          CatCube: Nonverbal people can communicate (e.g. through PECS, sign language, pointing to things they want, smashing things if they don’t get their mp3 player…). Nonverbal people cannot speak. This is an important bit of pedantry, because a lot of people act like we cannot know nonverbal people’s preferences when in a lot of cases we can.

          • CatCube says:

            I really feel like if research can give somebody the ability to ask for their mp3 player instead of using violence, that’s going to be a win-win for both the autistic and their caretaker.

            Until that day comes (if ever), we should work to make reasonable accomodations. However, saying that everybody is just going to have to live with this and it’s wrong to look for cures isn’t something I can get on board with.

          • Murphy says:

            With kids who aren’t so severely autistic teaching explicit reasoning about other people and how other people think and how they can influence the actions of other by communicating clearly are actually part of standard treatment.

            Drawing the trend line, with some severely autistic people part of the problem may be partly that while they may be physically and [theoretically] mentally capable of communicating they can lack the theory of mind to understand that communicating will get them what they want so you don’t even get pointing.

          • Mary says:

            ‘smashing things if they don’t get their mp3 player”

            If you use smashing things to communicate, some day, the thing smashed by someone trying to communicate with you — is going to BE you.

          • Creutzer says:

            Nonverbal people can communicate (e.g. through […] sign language[…]).

            No, they can’t, otherwise there’d be much less of a problem. Non-verbal doesn’t mean mute, it means having no language.

          • Chris Thomas says:

            A bit more pedantry: In everyday labguage, this is true; and I know you’re not a fan of ABA, but folks in that field use “nonverbal” to mean “unable to communicate” and “nonvocal” to mean “unable to speak.”

        • Alex Z says:

          Being non-verbal excludes one from a very large percentage of social, economic and educational opportunities. Not because of discrimination but simply because humans use verbal communication a lot to transfer information. Written communication may get you somewhere, but I bet only a small fraction of autistic non-verbal people are literate. In other words, being nom-verbal will likely result in one being poorer, less educated and have fewer friends. That seems bad.

          • Randy M says:

            Being incapable of participating in verbal communication is a disability. Having a preference to avoid it is a personality trait. I am unsure what exactly is being refered to in this thread.

          • HlynkaCG says:

            I’m pretty sure we’re talking about “incapable of participating in verbal communication” but I suspect that certain commentors are muddying the waters a bit for rhetorical gain.

        • Deiseach says:

          Yelling all the time might not be so great for your fellow-autistics who are sensitive to loud noises. It might even mean you have to separate and keep the yelling people away from other autistics, which kind of defeats the whole notion of community and everyone stand together and no problems functioning here, just the neurotypicals not accommodating the needs of the autistic.

        • Mary says:

          yelling all the time creates the danger that if the only way to get some peace and quiet is for your tongue to be cut out, some day, someone may do that.

          You may not realize how infernally unpleasant that is for some people. But it is.

          • onyomi says:

            I’m not autistic, nor super sensitive to noise (though I do wear earplugs at rock concerts since, seriously, they have it at ear damage levels–and I’m not too old–I was always that way) and I wouldn’t be able to stand living with someone who yelled all the time, especially if that yelling came on suddenly and without warning, as in “wakes up in the middle of the night screaming.” There’s just no way I could handle all the adrenaline dumps that would cause in me.

          • CatCube says:

            I was on a flight with my family about 15 years ago, and another family had a child with some sort of developmental disability. I don’t know what it was, but one symptom was that he would let out this pitiful wail about every 2-3 minutes.

            That 45-minute flight was, bar none, the most unpleasant air travel experience I’ve had, and I include being stuck on the ramp at O’Hare for an hour waiting for an arrival gate, and the 3-hour flight from Bagram Airfield, Afghanistan to Ali Al-Saleem Air Base in Kuwait on a C-130 where you were crammed shoulder-to-shoulder on a webbing seat with your knees interleaved with the passengers on the facing seats. It was like a cheese grater for your psyche.

            I know nothing about his parents, but being able to deal with that 24/7 makes them the most patient people I’ve ever run across.

          • Marc Whipple says:

            While most people here have probably seen autistics self-stimming/tantrumming/doing what some autistics do, at least on video, unless you have been physically proximate to it for an extended period of time, you literally cannot comprehend how distressing it is, even to a neurotypical person. If you are familiar with what Max Brooks calls “the zombie moan,” it works something like that. It’s not as bad, in that the person doing it probably doesn’t intend to eat you. It’s worse, in that you’re not allowed to shoot them in the head. (Not that you SHOULD. But after a while it begins to seem less unreasonable.)

            I am a person of reasonably calm demeanor and not especially sensitive to loud or unusual sounds. On the few occasions that my daughter has gone into a long stretch of making what I can only call “autism-related noises,” I began to understand people who institutionalize their children on an emotional level, not just an intellectual one.

          • Mary says:

            I may not be neurotypical but even tiny doses of it to me feel like my skin is being sandpapered.

          • David Kinard says:

            To add some credence to this, one time, years ago, I cursed at an autistic person who I didn’t know was autistic. I was driving my car, and I stopped for people using a crosswalk. A large man looked at me, and with a look of what I can only describe as pure hatred and fury, with gnashed teeth, screamed at me, the most horrible, primal, inhuman scream. I yelled back, “What the f*** is your problem man?” from my window. I was pissed. Something about that scream, just shot my adrenaline level sky high, like a fight or flight response. I was also a little, well, not scared exactly, but I perceived it as a dangerous threat.

    • Marc Whipple says:

      And therein, the problem. As you say, not calling autism a disease seems like a giant Eff-You to the mother of the child who gnaws his hands, etc. But calling it a disease seems like a giant Eff-You to the dinosaur kid. And, also, my wife, who believes herself to be on the spectrum* and was very insulted just now (thanks, Scott, thanks heaps) when I read her some of the contents of the article.

      *Note that while self-diagnoses are usually not all that persuasive, she has a degree in Psychology and has spent the last fifteen years studying autism up close and personal as well as reading just metric craptons of literature about it.

  7. Jay says:

    Matthews is a social justice warrior of the worst order, which is why VOX hired him.

    Take everything he says knowing he hates everything about the US, Western Culture, and the cis men he feels f*cked all us over by creating it and will push that agenda into all of his analysis.

    You can be certain he’s really not interested in the autism debate except to use it as a hammer to throw at the cis male medical establishment.

    That might be ad hominem, except here are three examples of the complete cock up that is Dylan Matthews.

    1) Today, Frederik de Boer and Erik Loomis complain about Dylan Matthews belief it is amoral for US citizens to want the economic lives of the poorest US citizens to take priority over the lives of the poor elsewhere around the world. (It’s oddly part of a general VOX defense of free trade, exporting jobs, and demand the US take down all borders.)

    2) In July, he got it terribly wrong not just about Bernie Sanders but the history of the Democratic party, progressives and open borders (Hint: Matthews hates borders, though Krugman literally says we can’t have universal health care without them.)

    3) In January 2013, he posted a mendacious infographic about false rape claims from an advocacy group, without bothering to fact check them or analyze them in any manner.


    Assuming I only get two links before being tossed into spam, I

    1) Dylan Matthews on the US poor



    2) Dylan Matthews on Bernie Sanders and Sander’s statement to Vox: “Open borders?” he interjected. “No, that’s a Koch brothers proposal.”


    “If I could add one amendment to the Constitution, it would be the one Wall Street Journal editorial page editor Robert Bartley once proposed: “There shall be open borders.” There is no single policy that the United States could adopt that would do more good for more people. An average Nigerian worker can increase his income almost 15-fold just by moving to the United States, and residents of significantly richer countries like Mexico can more than double their earnings. The humanitarian gains of letting everyone who wants to make that leap do so would be astounding.”

    So that’s Dylan Matthews who believes he is a progressive liberal but whose basic economic belief is from a WSJ conservative.

    You may agree with the WSJ position, but regardless, it is incoherent for a self-claimed uber liberal to think that open borders is the traditional democratic liberal policy.

    For more google: dylan matthews bernie sanders

    Dylan Matthews Is Upset that Bernie Sanders Thinks that U.S. Citizens Should Live Better Than Chadians
    Bernie Sanders’s fear of immigrant labor is ugly — and wrongheaded

    3) And he shrunk from his job as pundit to push clearly nonsensical stuff about the rates of false accusations of rape

    google: dylan matthews false rape

    See: The saddest graph you’ll see today
    An analysis so bad even Amanda Marcotte found it good for her own agenda to decry it (of course getting even worse.)

    See: overlawyered An in-faux-graphic on rape statistics

    Here’s the WAPO’s ombudsman on Matthew’s article (he corrects it, but still lets a lot of misleading nonsense get past.) (I was the reader who wrote to him)

    See: Patrick Pexton: A flawed image of rape on Wonkblog

    • “You may agree with the WSJ position, but regardless, it is incoherent for a self-claimed uber liberal to think that open borders is the traditional democratic liberal policy.”

      It was back before the 1920s.

    • Zakharov says:

      Given that liberals are generally pro-immigration, it makes perfect sense for an uber-liberal to be uber-pro-immigration. Sure, some conservatives support open borders, but some also oppose open borders, so Matthews can’t take a position of opposing every conservative. Also, publishing bullshit statistics isn’t shrinking from his job as a pundit, it’s the job of every pundit.

    • Roxolan says:

      > That might be ad hominem, except here are three examples of the complete cock up that is Dylan Matthews.

      “Ad hominem” is not just “attacks on the author that are untrue“.

    • Scott Alexander says:

      Banned for one month.

      • Hemid says:

        There appears to be a very strong correlation between how “blue tribe” your reading habits suggest you’re feeling, how uncharacteristically uninsightful and sometimes outright childish your commentary is, and how ban-relishing you are.

        You could examine that, maybe.

        • Nornagest says:

          I don’t see any evidence for relish here.

        • gbdub says:

          Oh come on. Jay’s post was a self-admitted ad hominem that wildly diverged from the topic of the OP into immigration, Bernie Sanders, and rape statistics. If that’s not shitposting than nothing is.

          That said, I do wish Scott hadn’t admitted one of his reasons for the reign of terror was to avoid giving “ammunition” to Blue Tribers who don’t agree with him and are anxious to smear him. I don’t think anyone in the Red Tribe or the NRx crowd is shaming Scott into being more Red or more NRx (or at least not successfully). That he’s willing to not only give into a shaming tactic but to publically admit that such tactics work on him seems to be rewarding the exact sort of nastiness that he’s spoken out against quite eloquently. Clearly it’s a delicate balancing act, but I sincerely hope Scott isn’t handicapping his own thoughts to be sufficiently palatable to the less-rational sector of the Blues.

          So I guess in short, I agree with the ban, but Scott, please don’t let the Reign of Terror into your own excellent brain.

      • RCF says:

        Is this banning purported to be in accordance with a previously articulated standard, or simply caprice?

        • Peter says:

          Given that a recently-reported standard was “reign of terror”, possibly both. Although I’d go for “unkind and unnecessary”.

          (Of course I’m one of these naive gullible fools who thinks that the only problem with the current reign of terror is that it doesn’t go far enough.)

          • RCF says:

            I guess I figured “unkind” referred to how one is treating other posters. His unkindness in the post under consideration is, as I can tell, directed mainly towards Dylan Matthews, who I assume is not a poster here. So that points either to “reign of terror” or one or more of my premises being faulty.

        • Whatever Happened To Anonymous says:

          To be fair, the previously articulated standards were just some west-coast hipster (is this the correct derogatory term?) way to say “don’t troll, don’t shitpost, don’t be an asshole”, which, in practice was really just “don’t be (too much of) an asshole”.

          I mean, I’m not a big fan of this whole “reing of terror” thing, but it’s not like we previously lived under consistently enforced rules (to be fair, most of us don’t live under consistently enforced rules anywhere, so it’s not like it’s a huge thing to adapt to).

      • Nero tol Scaeva says:

        The sound of thunder is traditionally associated with Thor smacking giants with Mjölnir.

        But no.

        That thunderclap is actually Scott Alexander smacking undesirables with the Banhammer.

    • David Kinard says:

      1 and 2 seem reasonable. What is moral about thinking people’s lives have more value based on their location of birth?

  8. ozymandias says:

    I have to say, I’m not terribly fond of “you have a very punchable face, therefore we are going to keep punching you, therefore we should eliminate the existence of punchable faces because of all the distress you are caused by us punching you” as a class of argument. I mean, gosh, think about all the classes of people we ought to eliminate by that argument. (Jews! Black people! Little boys who like playing with Barbie dolls!)

    In practice, “we don’t need a cure for autism” == “spend less of the research budget for autism on attempting to figure out a prenatal test for it so you can abort autistic babies, which probably won’t even work anyway because as best we can tell autism is super-complicated and probably like a dozen different things, and more of it on research about how to make caregivers less stressed out, nonverbal people more able to communicate, adults with autism more capable of working, and institutions less fucking awful”.

    It seems highly plausible to me that abusing people less improves their behavior, even if it is not a complete cure for everyone.

    And, to be fair, both your girlfriend and your ex-girlfriend are in the unemployed autistic adults numbers, and I’m a suicidal self-injurer– we’re not *just* people who like trains and flap.

    • Isn’t a major component of Scott’s argument that being severely autistic is still net negative even if society doesn’t treat you abusively?

    • Anonymous says:

      ozy, as an outside observer without any skin in this game, but who nonetheless has read a lot of both what you and Scott have to say about things, I don’t think you’re being charitable at all.

      Do you actually think Scott is making your caricature of an argument in your first paragraph? Do you *actually* think he disagrees with with your second paragraph?

      In your perfect world, how much of the research budget for autism should be spent on determining if it can be “cured” versus caregiving? How is that research budget currently split? (If you object to a framing of autism as something that can or should be cured, there are nonetheless autistic people who desire a cure. Do you ignore them?)

      • ozymandias says:

        If he agrees with everything the anti-cure movement is advocating for on the object level, it seems a bit silly to write a whole long blog post about how terrible it is.

        About a third of autism research money goes to identifying risk factors and an additional fifth to investigation of the underlying biology, both of which are primarily aimed at preventing autism. Twenty percent of the budget goes towards interventions, three percent for services, and less than one percent into research about autistic adults.

        And, yes, look at the bit about abusive institutions.

        • Anon says:

          I’m sure you know Scott a lot better than I do, but ignoring the object level and criticizing groups on the meta level/over an academic disagreement seems like an incredible in character thing for him to do.

        • Simon says:

          Hmm… “research money” is… what percent of the whole pie if you include the cost of medical interventions and inpatient care?

          “Research into services” is not an obvious category to demand boosting, or do I have this wrong?

          • ozymandias says:

            Well, you notice the thing where institutions are really awful and caregivers are burned out? It seems conceivably possible this could be ameliorated if there were more research about not doing that.

        • Those are figures on research money. If I correctly understand earlier comments in the thread–it’s not a subject I know anything about–the amounts spent on taking care of people with severe autism are much larger than the amounts spent on research.

        • David Kinard says:

          After doing some reading around the internet, there seems to be a fair amount of people whose activism consists of social justice type yelling at people who want a cure or who somehow imply that autism is a bad thing.

    • Alicorn says:

      Do housewives count as unemployed statistically? That seems like it would really weird statistics, although I’m not sure it would do so less than the obvious alternatives. How much money does my Patreon have to bring in how regularly before I’m a “crowdfunded freelancer” or something?

      • Justin says:

        People who are voluntarily out of work aren’t typically included in unemployment numbers, but more troublingly, people who are involuntarily out of work and unable to seek employment aren’t either. The actual rate of people who are not employed is much higher than the reported unemployment rate.

        • Mary says:

          Involuntarily out of work and able/unable to seek work is a crucial distinction. The first can be fixed by increasing the number of jobs; the second not at all by that method.

          You want to have the number of people for whom increasing the number of jobs will solve their problem.

      • ozymandias says:

        Looks like they were counting the number of people who had jobs, so yeah, we’re both unemployed for purposes of those studies. I don’t know how they’d count Patreon.

        Justin: This isn’t the economic definition of employment, this is the definition of employment where Scott took a bunch of numbers that said “4% of the sample was employed” and reversed them to say “96% of the sample was unemployed.”

        • Justin says:

          Which means 96% is almost certainly extremely far from accurate when framed in the way that the term is typically used. Gross.

          • Odoacer says:

            What’s gross? I don’t understand

          • baconbacon says:

            It isn’t perfect, but since LFPR is well above 50% a 4% LFPR (Which would mean 0% UE by the standard definition) is distinct enough to consider on its own terms.

          • Randy M says:

            Unemployed usually means looking for work, which wouldn’t tell us much about those too disabled to work. So I think Scott’s usage males sense.

          • Justin says:

            It’s gross because it’s a statistic that preys on people’s understanding of the common usage of the unemployment rate (the percentage of a population of people who are seeking work) but substitutes it with another statistic entirely (the inverse of the percentage of a population of people who have work).

            Saying that 4% of autistic people being employed means the unemployment rate among autistic people is 96% is only true if 100% of autistic people who aren’t currently employed are actively looking for work.

          • baconbacon says:

            @ Justin- it doesn’t prey upon anything of the sort. A 4% employment rate is stark enough in contrast the the general public that it gets across the main point- that there is something fundamentally different in either the ability or desire to work- the fact that the number might be “off” and could use a small amount more context doesn’t make the usage gross.

          • baconbacon says:

            To clarify some more- if the general LFPR was reflected in autistic people (~62% in the US) then the appropriate UE rate would be ~93% not 96%.

          • nohbdy says:

            Gross: social justice for “I disagree, and if I had my druthers, you’d be going to a reeducation camp.” These days, the word “gross” being applied to ideas or people is a useful shibboleth.

          • Nornagest says:

            I’m no social justice fan, but can we not go around accusing people of wanting to throw us into reeducation camps without, you know, actual evidence to that effect? Seems like a reasonable concession if we don’t want them accusing us of doing things like running the entire economy to support the cause of white supremacy.

          • RCF says:

            “It’s gross because it’s a statistic that preys on people’s understanding of the common usage of the unemployment rate ”

            I don’t think most people understand what the “common usage” of the term is, and if there is confusion, the majority of the blame lies on the people using “unemployment rate” to mean something other than the percentage of people who are unemployed.

          • Mary says:

            if there is confusion, the majority of the blame lies on the people using “unemployment rate” to mean something other than the percentage of people who are unemployed.

            They aren’t.

            The fun lies in defining who is unemployed.

            The vast majority of people, thinking of the unemployed, think of someone who can’t find a job while looking. They do not think of a house husband, a heiress who spends her life volunteering, a child in school, etc. And it is useful to draw this distinction, because the people they are not thinking of often do not have a problem, and when they do, it’s not a problem amenable to the sorts of fixes that would fix the problem of the guy who just can’t find it.

            A WWII era government pamphlet observed that they were enjoying over-employment — people of retirement age were still working, people who would normally still be in school quite and took jobs, people who would not work took jobs — and yet I suspect that most autistic people would still have trouble finding a job then.

            Alas, there is no term for a person who would probably be employed owing to age and lack of wealth if it weren’t that he was unemployable.

      • HlynkaCG says:

        Unemployment is usually defined as the % of people who are looking for jobs but do not have one. Otherwise you’d have a lot of infants and retirees screwing with the numbers.

        Of course this is why you also have to take politicians with a grain of salt when they say that “unemployment is going down”.

        • RCF says:

          Unless the percentage of people excluded from unemployment numbers is increasing, it is irrelevant to the validity of claiming that unemployment is decreasing.

          • HlynkaCG says:

            It’s extremely relevant.

            Reducing unemployment is a laudable goal, and yet we are not forcing large numbers of people into early retirement or simply euthanizing unemployed adults.

            A less extreme example would be to determine whether an observed reduction unemployment is a result of increased availability of work, the previous generation retiring en mass, or some other factor.

          • Mary says:

            It increases and decreases all the time. Anyone who’s given up the search in despair no longer counts.

            This is why job growth can fail to decrease the rate; people get hope and start searching.

          • RCF says:

            The word “unless” signifies that the latter clause applies only in cases when the initial clause does not obtain. Thus, in this case, my post states that irrelevance occurs only when the percentage of people excluded from unemployment numbers is not increasing. Forcing people into early retirement or euthanizing unemployed people would increase the number of people excluded from unemployment numbers, and thus would make my statement not apply.

            IOW: You have failed the Turing Test.

          • HlynkaCG says:

            In labor terms infants, retirees, and the deceased are all null values. You can’t exclude someone who, for all intents and purposes, doesn’t exist.

            I also find it ironic that a commentor who communicates primarily in if/then statements and has trouble parsing fiarly typical examples of human speech would accuse someone else of failing a Turing Test. =P

          • RCF says:

            “In labor terms infants, retirees, and the deceased are all null values. You can’t exclude someone who, for all intents and purposes, doesn’t exist.”

            Word games.

            “I also find it ironic that a commentor who communicates primarily in if/then statements”

            I don’t see how this either true or relevant.

            “and has trouble parsing fiarly typical examples of human speech would accuse someone else of failing a Turing Test.”

            I explained quite clearly how you failed to properly parse my statement. You have responded with the completely unsupported assertion that I have trouble parsing speech.

    • Anonymous says:

      Constantly trying to self-harm or harm others because of sensory overstimulation does not seem a case of “distress because we are constantly punching you”

      • Justin says:

        I don’t mean this to sound condescending, but unless you experience it firsthand, it may be difficult to understand that sensory overstimulation is an external factor, not an internal one. Sometimes it’s literally distress from other people’s punches, but even when it’s not, it’s still most commonly distress triggered by stimuli created in some way by other people.

        Accommodating for autistic people’s sensory sensitivities decreases their tendencies towards such behaviours. The kind of deliberate immersion therapy that people like Kanner suggested (and engaged in first hand) certainly increases them, but so does the kind of inadvertent immersion therapy that comes with everyday life. And when you’re put in a situation like that, self harm and harming others can become the kind of last resort that seems necessary to escape it.

        • keranih says:

          it may be difficult to understand that sensory overstimulation is an external factor, not an internal one. Sometimes it’s literally distress from other people’s punches, but even when it’s not, it’s still most commonly distress triggered by stimuli created in some way by other people.

          Yes, it’s difficult to understand. Can you (or someone) elaborate? To me, sensory over stimulation sound akin to the immune hyper-reaction from a bee sting. Two people might experience the same stimulation, but due to a factor intrinsic to one person, and not the other, there is an elevated response that could threaten the life of the person with the sensitivity factor.

          How is this incorrect?

          • Justin says:

            A bee sting is not really comparable, as the reaction there is biological rather than neurological. A better way of thinking about it might be to think of a volume control.

            Let’s say a TV being watched in a common area has a digital volume setting on it that goes from 0, where the sound is completely silenced, to 100, where the sound is so loud it’d probably actually bust the speakers. During normal usage, it’s set at 20. But not everybody in the room watching TV perceives the volume the same way. Someone who has hearing loss might want it at 30 in order to better make out what the people on TV are saying when they’re just using a normal speaking voice. Someone who is hungover and has a pounding headache but still just wants to see the show to put themselves in a better mood might want it at 10. Someone with tinnitus might want it above 10 because if it’s too low, the constant ringing in their ears becomes more noticeable, but under 40 because they don’t want to damage their ears any further.

            The TV volume is an example of a stimuli that’s external and triggered by other people because it’s something objectively observable in the real world using one’s own senses, but is under the control of whoever happens to be holding the remote. The reason they would rather experience it differently is internal and unavoidable, but the forces that make them experience it differently are external and controllable.

            Now imagine applying this to not just the TV’s volume, but to a variety of types of sensory inputs across all the senses. And then imagine being particularly sensitive to these inputs the way the people I described in the volume example are. Autistic people can be sensitive in this same way to things that you wouldn’t think of to be sensitive to. It can be relatively mundane like, yes, the volume of a TV. Or it can be similar, but applied to a sense where it makes less obvious sense, like touching a surface that’s well within a normal person’s temperature range, but just feels too cold somehow. Or it can be something really out there and really specific, like one of mine is not liking the way playing a kazoo feels or the way a kazoo sounds because it reminds me of the way playing a kazoo feels. Don’t ask me to explain it, that’s just the way my brain works. I’m not especially sensorily sensitive this way the way some other autistic people are, but that’s one of the ones that gets me.

            But then all of this can also apply to broader (yet, at the same time narrower examples of) stimuli, like specific types of social situations. I absolutely abhor getting a haircut. It’s not the sitting in the chair making small talk with a near stranger (but that also sucks), it’s the actual process. It makes me very uncomfortable and I always end up putting it off as long as I possibly can.

            These are all situations that can be accommodated for to varying degrees, but that accommodation has to be external, as the internal response to a given stimulus is essentially fixed. I can’t possibly change that I don’t like the sensation of kazoos, to go back to that extremely specific example, but I can avoid playing one myself, and if people are aware of my admittedly weird sensitivity, they can avoid playing one around me or, more importantly, trying to force me into playing one myself. I can’t stress that last part enough, not just with this specific example, but with all examples of these kinds of sensitivities and aversions. Immersion therapy is not the solution. To be clear, I’m not saying college textbooks should come labelled with trigger warnings for kazoos, just that the primary accommodation for this narrow aspect of autism should be acceptance of differences like this that autistic people may have. I haven’t violently struck out at people for giving me a haircut, but I have hurt myself when repeatedly forced into other situations that my brain literally not wired to handle. If other people had been aware of this at the time, it might not have happened.

          • Peter says:

            The thing about “external and controllable”. I think you’re reasoning goes, “if the bit that matters is external, the whole thing is external, the bit that matters is the bit that can be controlled, the bit that can be controlled is external, therefore the whole thing is external”.

            Your TV example is interesting; hangover-guy and hearing-loss-guy have conflicting needs. If they both want to watch TV in the same room… maybe hearing-loss-guy could get headphones for extra volume, maybe hangover-guy could get noise cancelling/isolating headphones to muffle the volume. Maybe they could turn subtitles on. Maybe they could find a compromise volume. All of these solutions are going to involve one or both of them accepting an inferior experience. Hearing-loss-guy could say, “your hangover, your problem”, but maybe hearing-loss-guy likes getting drunk as much as the next guy and doesn’t want to be a hypocrite. Maybe hearing-loss-guy went to too many loud rock concerts when younger.

            Elsewhere there’s the case of the access needs conflict between the person who’s OK if there aren’t sudden loud noises, and the person who needs to be allowed to scream without warning for no reason.

            Actually finding good compromises is hard. It’s tempting to imagine some lexicographically-ordered hierarchy of needs where all autism-related needs take absolute priority over all non-autism related needs, but a) hahahahahaha and b) internal conflict between autism-related needs. If we don’t go down that route, then other people aren’t something you can so easily control for.

            The difference, I suppose, with the bee sting, is that bees aren’t typically regarded as a full part of our moral community – we might have duties to bees (or duties to ourselves/other humans which result in things resembling duties to bees), but they don’t have duties with regards to us. Bees are, among other things, forces of nature.

            Other people, for me, can sometimes have something of the “force of nature” thing about them too. So not so controllable.

          • Justin says:

            Oh, I’d never argue that there’s any sort of easy blanket solution for dealing with things. That’s why I mention that it’s mostly a matter of awareness and acceptance more than one of solving problems, because even if it doesn’t actually go anywhere, at least somebody thought that caring might be an option, that maybe at some point somebody could compromise. That’s how low the bar is set at this point.

            Subtitles, in the metaphor, are really the best anyone with needs different from baseline can reasonably expect, but we still live in a world where (again, metaphorically) half the shows don’t even have the option yet and where there’s very often someone at the other end of the couch that will shout you down for asking to turn them on and will punch you square in the face if you try to turn them on yourself.

          • Peter says:

            I think my personal experiences are a bit further along the line; in my previous job my line manager was a very nice, softly spoken person. When I got my diagnosis the diagnosis people and I wrote a letter to employers. I showed it to my boss, and he said most of it was things we were doing already; this was true, most of it was things we’d worked out between us before having a diagnosis or even believing Asperger’s was even a possibility. Maybe I was able to get things a bit more liveable-with, but I had a lot of frustration where the things I felt I needed were things they didn’t feel they were able to offer. I… resigned myself to being unhappy and sort-of did some looking for jobs (but felt that a move might be out-of-the-frying-pan-into-the-fire) until I got poached by my current job. And the problem is still there, to an extent, although I’m a lot happier where I am now.

            This sort of experience has really brought home to me how bad attitudes aren’t the whole problem, and that working to remove those bad attitudes is necessary but insufficient. And how some problems can only be counted as “external” if you have an unrealistic view of what the world can be expected to do for you.

            This probably counts as seriously good luck in my part, OTOH better luck would have been for me to have not needed all that in the first place.

          • keranih says:

            @ Justin –

            Thanks for the long explaination. I appreciate you trying to make your point more clear.

            If I have this right, you consider hypersensitivity to be external because the insult comes from the outside, and you have no control over it, is that right?

            If this is so, then we are talking past each other, I think, and you’re not any closer to convincing me that the issue with hypersensitivity is something ‘not typical’ with the world, rather than something ‘not typical’ with the autistic who suffers from it.

            On a more general note – you place agency on other people as the cause of the discomfort, because the sound, etc, is something that people make.

            What is the data out there concerning the interactions/sensitivity that autistics have with “natural” phenomenon like thunder, rainstorms, rustling leaves, season changes, sunlight and clouds, etc ? Are the stimulations that cause such misery all human in origin, or can they come from any source?

            (Neurological not biological – it’s all biological, until you get to the point where it’s all chemical, or until you go past the chemistry and it’s all physics.)

          • Justin says:

            I’m not arguing the issue is something not typical with the world, I’m arguing that something perfectly typical for the world can adversely affect people who themselves aren’t typical and that those people’s differences, given that they’re beyond their own control, should be accommodated for.

            And I’m not really talking about agency when it comes to creating the sensory inputs at all, purely about how they are handled by people who have agency. For example, if an autistic person is sensitive to a given natural phenomenon (which, yes, is absolutely a thing), I’m not at all arguing the solution is to get rid of lightning or whatever, it’s for others, when they are aware of the situation, to accommodate for that sensitivity by, at the very least, not shoving them outside in a thunderstorm. Let them stay indoors until the storm passes, even if it means being late to the party. Let them wear hearing protection and close their eyes, even if it makes them look weird. Pay attention when they communicate to you that this is an issue for them (which, given the societal shame involved, isn’t just an issue for “low-functioning” people who are nonverbal), even if the issue seems really out there and hard to understand.

            Perhaps accommodations is the wrong word for getting my point across and something more along the lines of allowances would make more sense.

          • CatCube says:


            You do understand that neurotypical people have psychological needs as well, right? To use your example of a thunderstorm causing someone to be late to the party or to mew themselves up for the duration, both of those things can vastly complicate planning a gathering and are insulting to others present.

            I’m not saying that it’s not a good thing to accommodate somebody, and I think that a good friend would do so. (In the example given, the rudeness of being late or withdrawn at a gathering is something that neurotypical people do, and it often gets overlooked–for a while.) However, having a friend who needs to be wrapped in gauze can be wearying and it’s not hard to see where invitations to spend time with someone might start to taper off if that’s a constant expectation.

          • Justin says:

            I’m absolutely aware of that. You may have noticed that I did not include inviting people to parties as an example of an accommodation. You’re under no obligation to befriend autistic people, just be aware of how you treat them if you do.

          • David Kinard says:

            Justin, fascinating. Very well described. Gives me a much better idea of what;s going on. Nails on a chalkboard. Only the chalkboard is a kazoo.

          • David Kinard says:

            Could you explain why the self harm thing seems like the response to that?

          • David Kinard says:

            Also, it seems like if you could, you would want to get rid of the extreme sensitivities. If that part alone was gone, do you feel it would impact your sense of self? If so, how so?

        • Peter says:

          I experience this firsthand. It’s… well, “internal factor” and “external factor” are both wrong, it’s an internal-factor-external-factor interaction, but there’s definitely an internal factor there, a difference that makes all the difference.

          Elsewhere people were talking about prosthetics, I suppose the one I’m using right now is a pair of noise-cancelling headphones, which my line manager has suggested that work could pay for, but I’ve decided I want them to be mine, bought with my money, because as well as noise cancelling I wanted good sound quality. They are less useful than I thought they would be – the noise cancelling is good for cancelling low constant rumbles like server fans (this doesn’t bother me so much), but not so good for cancelling people’s voices (more likely to be a problem) or the clicking of keyboards – which doesn’t usually bother me but if I get in the wrong mood even that becomes a problem.

          It’s that mood-dependence that’s a big thing. It’s much harder to say that something is an “external” factor when my own reaction to it varies so much.

          • Justin says:

            Well, your mood and context varies the severity your reaction, but that’s true of pretty much anything for anyone.

            That you have a reaction to those types of things at all when most people would be able to just dismiss them as completely normal background noise if they even noticed them at all is the difference for you as an internal constant (even if the individual triggers change with context or with time, that such triggers exist stays the same) and the stimuli themselves are still totally external variables that you’re able to tweak with the headphones.

          • Peter says:

            The thing is, quite a lot of my problems are things that feel to me like differences of degree rather than differences of kind. One enduring frustration is where there was something that I appeared to be less able to cope with than most people, and I wrote it off as “one of those things”, and when I got my diagnosis I started to say, “maybe the AS is behind that after all”. Then when I’m explaining my troubles to people, they say, “oh, but we all get that”. Explaining to others, “not like I do”, can be difficult.

            I suppose there’s a great deal of difference within the spectrum.

          • brad says:

            I want them to be mine, bought with my money, because as well as noise cancelling I wanted good sound quality. They are less useful than I thought they would be – the noise cancelling is good for cancelling low constant rumbles like server fans (this doesn’t bother me so much), but not so good for cancelling people’s voices (more likely to be a problem) or the clicking of keyboards – which doesn’t usually bother me but if I get in the wrong mood even that becomes a problem.

            Completely off topic, but what you want are headphones with good isolation, not active noise cancellation. If you can tolerate them in-ear monitors are relatively inexpensive, have excellent isolation and pretty good sound quality (great except for bass). If not you’ll need to go the closed circumaural route. They are somewhat more expensive an may need a separate headphone amp. On the upside they have better bass than IEM.

          • Peter says:

            Yeah, my work phones are closed circumaural – Bose QuietComfort 15. There’s definitely quite a bit of muffling even when the noise cancelling is turned off – the active cancelling seems to do much more for the bass rumbling of server fans etc.

            There are times when we had teleconferences, where I sat at my desk with a headset, and a colleague sat at his desk facing mine also with a headset. Listening to his voice both through Skype and through the air was too much, so I switched to using my noise cancelling headphones (and dangling the headset round my neck for the mic). This is good – except speaking with them on is weird as you can’t hear your own voice as loudly as usual.

            Recently I got a smartphone, and it came with some in-ear headphones. It seems I tolerate them quite well – I’ve been looking at getting a nicer pair, sound isolation would be very handy. Possibly noise cancelling on top would be nice the next time work puts me on a plane…

            I’ve been watching some professional games of Starcraft 2, where it’s really important that the players can’t hear the audience (especially if one player is making preparations for an early attack and the other one is close to discovering them), and they seem to use industrial ear defenders over the top of in-ear headphones.

          • brad says:

            What came with your smartphone are probably earbuds, not in ear monitors. They are in the same general neighborhood but IEM are designed to go further into your ear and form a complete seal. The really expensive ones are custom molded to your ear (the less expensive ones have a compressable piece that expands to form a seal). Even relatively inexpensive models provide isolation similar to really expensive closed DJ headphones. I can see why the starcraft tournaments might want to make double sure with an isolating headset — a player could break the seal and it might be hard for a judge to notice — but unless you are working with hazardous noise levels it probably isn’t necessary.

            Speaking when you are wearing headphones with strong isolation is definitely a strange experience.

      • ozymandias says:

        From the inside, self-harm due to sensory overstimulation *definitely* feels like I am a perfectly reasonable person with perfectly reasonable preferences and other people insist on having car alarms.

        But, no, I was referencing Scott’s bit about abusive institutions and the ease of changing society vs. biology.

        • David Kinard says:

          I know it’s incredibly difficult to communicate a unique experience like that to someone who has no reference frame for it. I think the self-harm thing, from an outside perspective, is the most disturbing aspect. The closest thing I could imagine would be where I get bad anxiety because of some claustrophobic type experience, like I get in really bad traffic, and my fight or flight or response kicks in, and it is incredibly difficult to supress. Jason had a comment that really explained the overstimulation thing. That made me understand, I likened it to nails on a chalkboard.

          Internally, could you try to explain what the self-harm or the stimming stuff feels like?

    • nohbdy says:

      A few months ago, you were asked whether you would defend the continued existence of non-molesting, non-exclusive pedophiles against genetic engineering or prenatal screening, just as you defend the continued existence of other forms of “neurodiversity” and deafness. As I recall, your answer was “no”.

      Now personally, I’m not particularly invested in the creation of new minds like my own. But, unless you’ve changed your position, it looks kind of hypocritical. I might begin to suspect that the tolerance does not extend to “neurodivergence” that the social justice zeitgeist says is icky. And I am not particularly inclined to fight a culture war alongside those who are unwilling to grant any concessions to my culture.

    • Deiseach says:

      ozy, I’m all for what you say there about “how to make caregivers less stressed out, nonverbal people more able to communicate, adults with autism more capable of working, and institutions less fucking awful”.

      I’m even for that when it comes to other pre-natal screening such as for Down’s Syndrome, and I agree that it’s likely a test for autism would result in the same path as for Down’s Syndrome (quoting Wikipedia): “About 92% of pregnancies in Europe with a diagnosis of Down syndrome are terminated. In the United States, termination rates are around 67%, but this varies significantly depending upon the population evaluated.”

      But the hostility towards talk of a cure (if there ever could be such a thing) means that (a) research that may be helpful towards finding ways for improved communication and integration gets unfavourable attention because isn’t that trying to force the autistic child to be “normal”? Leave them alone if they (can’t) don’t talk! (b) it doesn’t help the people who have family members who are beating their heads off walls to the point of physical injury, because they’re not seeing the quirky, fun, ‘who wouldn’t want to stim, it’s so great!’ side of autism and they’re supposed to shut up and not make things worse for the functional autistics.

      I don’t know if my father’s side of the family are autistic/high-functioning/Asperger’s; I certainly suspect it because we’re all so fucking weird in our various little ways and we end up on psychiatric medication eventually (this is part of why I’m resisting so hard asking for medication for possible depression).

      It’s not happy happy joy joy. It’s not finding our own little niche and cabal of like-minded others where we can enthuse over maths and obsessional interests. We don’t even get on with each other because we rub each other up the wrong way (at any given time, half the family are not talking to the other half, and we are all very solitary and don’t interact like ‘normal’ people with siblings and extended family). It’s constantly being out of step, just that little but crucial bit, with the world. And we would be collectively happier, I think, if there was something – maybe not a cure, “cure” is a very strong word and I don’t think there is going to be an easy way to tackle autism, but if there were some pill or treatment or something to help us not be So Bloody Odd, I’d take it! We’d take it!

      I don’t know how you feel about yourself. For the autistics who do manage to be functional, who struggle on in the world and make something of it and themselves, that is great and I wish you good luck. But it’s not like that for everyone.

    • Scott Alexander says:

      I bite your bullet and find that it tastes like delicious chocolate cake.

      What if we actually punched people who had punchable faces? What if there was some small class of people who couldn’t go outside the house without somebody breaking their nose, because their face had some characteristic – let’s say acne – that made everyone else think they were “punchable”?

      And suppose that these people almost all died of concussions at a young age, and that the social norm of punching them was really deeply ingrained – as deeply ingrained as the sort of really deep structural racism that everyone agrees it will be decades or centuries before we get rid of if ever, or as deeply as Sarah says the problems with institutions are. Suppose everbody agreed that we should have public awareness campaigns to tell people to stop punching everyone with acne, but that it would probably take fifty years to work and in the meantime everyone with acne would be locked in their house or dying of concussions.

      Shouldn’t these people also have access to acne treatments? Especially if there were really good ones that caused their acne to clear up in a couple of days and never bother them again?

      The more I have to deal with institutionalized psychiatric patients, the more I feel like the world is on fire, and we’re arguing about whether the fire hose should have 100% pure Perrier spring water or whether Aquafina is okay. We can worry about that after people stop burning to death.

      This is part of what I was grasping towards in the story about the hair dryer. Sure, in a perfect world I would love to solve the patient’s problems by curing her obsessive-compulsive disorder so thoroughly that she never has to worry about it again. But that would take twenty years and she’s on fire now. Telling her to take the hair-dryer with her in the car is a stupid quick-fix hack solution, but it puts out the fire and allows her to live a normal life and so I will swallow my pride and take it.

      And Jews tried the “become indistinguishable from everyone else” strategy. Hitler just looked up our grandparents’ birth records in the national archives. If Jews could actually vanish into the general population at a moment’s notice so thoroughly that Hitler could never find them, history would look a heck of a lot different today, and I would be the last person to demand that they be denied that opportunity.

      • Meredith L. Patterson says:

        Does the therapy available to profoundly autistic patients in institutions include occupational therapy for sensory processing disorders?

      • HeelBearCub says:

        @Scott Alexander:
        “I bite your bullet and find that it tastes like delicious chocolate cake.”

        Not to question your self-reported emotional state, but, really? I mean doesn’t you acne example look a lot look “nerdy kid”? I think that, here, we are all pretty sure that the answer to poor acceptance of nerds is not actually “cure nerdiness”. Sure, try and “cure” acne but, what will the penetration of the acne cure into the populace of adolescents be? And how good will the cure be? Will it cure past damage, or just prevent future damage? Will we still judge that all the kids who had acne and didn’t get it cured before blemishes are “punchable”?

        Now, does that mean that there is no need at all for a “cure” for acne? No. But it also means that the root problem that causes a huge chunk of the harm will still exist and also needs to be “cured”. And really, both issues need to be treated, as cure seems like it will magically just make everything fine, which seems unlikely for acne and autism both.

        None of which means I think it is right to say “We don’t need a cure”. I think the right thing might be “We need effective treatments for autism, and we need to be able to apply them as early as possible”.

        Maybe that is me biting the bullet as well. But I think it tastes like crap.

    • Simon says:

      Can I be in favor of less punching but also giving people the option of becoming less punchable?

      In my case: I have always been somewhat fat. (Yes totally different. Please do not say I said they were equivalent categories in any way.) I would love it if society thought being fat was awesome or at least neutral. I would also love a pill that made me lean.

      I think your framing is confusing the issue. You’re making it sound like *I* am the one punching and I am going to *eliminate [your] existence*. But… say I frame it as: yes society sucks and I sadly can’t change it, but I can offer you this pill to make your life better. How can that be wrong? Am I bad for giving you the option of not suffering for the sake of an identity group you may or may not identify with? I don’t think I would feel bad…

    • David Kinard says:

      More generally, there’s a bit of unexamined thinking there going into the idea of prenatal genetics. I support transhumanism, and think genetic engineering is both inevitable and has inconceivable positive potential.

      People have a lot of trouble when they cross over different modes of thinking for different purposes. We understand the brain as being a physical thing, that consciousness emerges from. We also, on a day to day basis, treat people as agents, who have will and responsibility. We have to, that mode of thinking is totally necessary for human interaction. The problem becomes when those two modes intersect. People have a hard time reasoning about mental illness. They try to create boxes to preserve their agent boxes to matters of physics. Trying to separate people from their brain. Sometimes this even works. A person who is drugged against their will is not responsible for their behavior. But other times, it gets more dicey.

      As we learn more and more about genetics and the brain, the new knowledge will make it harder for us to apply our old ways of daily agent-person thinking.

      Autistic people may not want a genetic cure, because they feel without those genes, they wouldn’t be “them”. But what if the cause of autism was environmental? And we had a choice to remove this chemical or not from the environment? Does that seem like a different ethical question?

      For my part, I have a severe disability. Now, my case is different, because there’s no part of my disability I like. And, well, society doesn’t accomodate me, but it would be nice if they did. And I want a cure. Furthermore, my disability has affected my identity. Surely, I would be a very different person without it. But if I could, i would still wave a magic wand and undo that.

      Of course, for the high autistic people, it’s a different situation. The autism is not something they could imagine themselves as not having.

      I don’t have a problem with prenatal genetic engineering to cure my disease. Even though it wouldn’t have been “me” exactly, had my mother had it done. I am not going to have children ever. I feel like it would be unethical to give them these genes. Does my decision somehow discriminate against the people who won’t be born? What about the fact that I decide to have sex on wednesday instead of tuesday? What about the particular sperm-egg combination difference that makes? Am I being unfair to some future hypothetical person?

      On another note, I’m not really sure how one can be in favor of abortion, yet against aborting children because they will become autistic. If the logic is it’s ok to abort because the fetus isn’t a person and doesn’t have any rights, how would them having autistic genes suddenly give them rights? Why would it be ok to abort, as long as the mother doesn’t know anything about the child’s genes?

      It seems to me alot of the sentiments behind this anti-cure movement are based on some very odd, unexamined premises which get compounded by the identity politics aspect and extended into that same “questioning this means you hate group x” tautological logic. (This is based on doing some reading around the web for other instances of this discussion.)

  9. onyomi says:

    You find, “if there were a cure for autism which had to be administered in the womb parents would have a moral obligation to use it” more controversial than:

    “On the other hand, if a mother wanted an autistic child, and she was somehow sure that she could support that child and help him or her flourish, I would be okay with her aborting however many neurotypical fetuses it took.”


    Not only does the latter strike me as much more extreme, but it seems the former would preclude the latter: if parents have a moral obligation to cure autism if they can, how can they be justified in killing non-autistic fetuses in hopes of creating an autistic one? “Doctor, please kill this child which is more likely to have a happy life; I’m trying for one who is more likely to be unhappy.”

    Also, by conceding that the fetus’s *potential* for future happiness or unhappiness matters, doesn’t that kind of imply its future moral agency, which will almost certainly one day exceed that of a cow, matters as well?

    • CatCube says:

      One pro-choice to rule them all, One pro-choice to find them…

    • Anon says:

      I think Scott is addressing a very specific situation where treatments for the autistic is so good that the mother can practically guarantee her child won’t end up in the “Screaming all the time and biting off your hands” situation described in the article, but as long as that possibility exists (with reasonably high probability) there’s the moral obligation to prevent it.

      It seems like a rather obscure point to argue, and I worry it detracts from the piece, but what I think Scott’s getting at is “Look, I don’t think autism is always and immutably bad; if a mother wanted an autistic child and was confident it’d be happy I’d be perfectly fine with here having one”.

    • nohbdy says:

      Future experiences only matters inasmuch as they are actually experienced. Killing a (1st trimester, for the sake of avoiding side-arguments) fetus prevents the moral patient from ever existing. Cutting off a fetus’s thumbs, but otherwise allowing it to mature normally, causes a person to be made to live without thumbs.

      • onyomi says:

        If I painlessly kill a homeless person no one will miss, would that be okay?

        • hamnox says:

          Does the homeless person’s desire to continue existing not count as a preference worth satisfying?

          … why is the person no one will miss always homeless anyways?

          • Anonymous says:

            Presumably because if there is someone who cares about you then they will be willing to let you live with them if the alternative is being homeless.

          • As a social worker who works with homeless youth: the homeless are quite often friends with each other

  10. “As best I can tell fetuses have less personhood than cows”

    Whoa, there, Scott! Fetuses at what stage of development? Do you really think that a fetus at 8-1/2 months has less personhood than cows?

    • Don’t have a source, but I’ve seen it suggested that cows have more personhood than infants. They seem to have approximately equal or perhaps higher ability to feel pain, solve problems, and communicate with others. What leads you to believe the opposite?

      • Wrong Species says:

        Maybe we should define personhood before debating it.

        • keranih says:

          For what its worth, I think we can discuss treatment (or not) of things which are a disease (or not) without opening the huge and slightly derailing cans of worms which are abortion and animals rights.

          I’m not telling anyone what they can or can not focus on, but me, I’m going to try to not go there *this* post.

        • baconbacon says:

          Catch 22- can’t define something without debating it.

        • Urstoff says:

          No one wants to do that, because for consistency’s sake, you end up with either late-term abortion being impermissible (which seems reasonable to me, but may seem like a wedge into the complete banning of abortion to others) or infanticide being permissible.

          Unless you make special exceptions for the fetus being human, of course.

          Edit: assuming JJT-style counterexamples don’t work, which I don’t think they do.

        • Earthly Knight says:

          There is probably no need, because on any plausible, species-neutral precisification of “personhood” a cow is going to have more of it than an eight-month fetus.

      • Mary says:

        Cows have more personhood than sleeping people, by that definition.

        If awake, of course.

        (Hmm. Not sure about the pain. But then you just need to put in a person incapacitated by alcohol.)

        • Earthly Knight says:

          Cows have more personhood than sleeping people, by that definition.

          This is wrong: I do not lose my ability to play the guitar, or speak French, or problem-solve when I take a nap. Abilities endure through at least brief periods where they cannot be activated because their bearer is indisposed. You might be able to make a stronger case for coma patients, though.

          • Brad (the other one) says:

            By all means, provide a video of yourself playing guitar and singing French in your sleep. I’ll wait.

            If one may say, “You misunderstood, I can exhibit such abilities after I wake up.” I shall say “And so can a fetus after maturity to adulthood.”

          • Earthly Knight says:

            Your reasoning depends on the principle that one cannot have the ability to do something unless one can currently exhibit that ability. This principle is false. Do you think that you lose the ability to drive a car while using the toilet? If not, I ask that you provide a video of yourself doing both simultaneously.

          • Who wouldn't want to be Anonymous says:

            @Earthly Knight

            Easy! I’ve done it numerous times before, both intentional and not.

          • Earthly Knight says:

            You have a toilet installed in the driver’s seat of your car? Note that the question I asked is not and is not elliptical for: “Do you think that you lose the ability to urinate while driving?”

          • Mary says:

            “I do not lose my ability to play the guitar, or speak French, or problem-solve when I take a nap.”

            Yes you do. Until you do all three in your sleep.

            If you want to claim it’s not significant, that’s another kettle of fish. However, the question of personhood by stopwatch is — fraught.

          • Earthly Knight says:

            As I said above, it is not a plausible condition on my having an ability to do x that I can do x at that exact moment. It would be false to say of someone using the toilet that she no longer has the ability to drive. It would be false to say of a perfectly ambulatory veteran that she lost the ability to walk during the war (in virtue of having occasionally slept). It would, moreover, be false to say of someone moving a television that she does not have the ability to watch TV (it being impossible for her to move the television and watch it at the same time)– in fact, the reason why she is moving the television is precisely because she has the ability to watch it.

          • Mary says:

            “As I said above, it is not a plausible condition on my having an ability to do x that I can do x at that exact moment.”

            Except that shifts the goalposts. You can’t do x at that exact moment regardless of your external circumstance is what was at dispute.

          • Winter Shaker says:

            If one may say, “You misunderstood, I can exhibit such abilities after I wake up.” I shall say “And so can a fetus after maturity to adulthood.”

            I think it a reasonable difference is that the Francophone guitarist is regularly conscious every day before going to sleep, and has hopes and plans for when they wake up again the next day, and is connected to a web of social interaction, such that if the guitarist died peacefully in his sleep, his friends and family would still suffer grief, and if the guitarist knew in advance that there was a high probability he was going to die while asleep that night, then he would live every day in fear that all his hopes and dreams and future happiness would be wiped out. None of these considerations apply to the foetus – and your claim about the foetus also proves too much, insofar as a putative future person which is currently in two parts, a sperm cell in one putative parent’s body and an egg cell in another, will also, if those people have sex, and a whole host of other things happen in an orderly fashion, be capable of playing guitar and singing in French, and yet we do not think that people have an ethical duty to maximise the number of potential future people transformed into actual people, and therefore an obligation to have sex with every fertile prospective mate at every opportunity.

            I think we can usefully distinguish between
            a) things that are to quite a high degree conscious and capable on an intermittent basis, such that even if they could be dispatched suddenly and painlessly, their desire while conscious to avoid that, and the distress caused to those who would miss them, would be considerable (which would include adult and older child humans)

            b) things which are conscious and capable to a moderate degree, again intermittently, which are probably not capable of consciously anticipating their own extinction and fearing the loss of their potential future experience, but which possibly do feel some distress when someone else has been taken away from them, and

            c) things which are not conscious at all, or only to a small degree, which are not able to experience distress at the prospect of their future being curtailed, which would include foetuses and the prospective-future-persons-embodied-in-two-gametes-that-have-not-yet-met in the scenario described above …

            …and deciding how morally relevant those differences are. Does that cut through any pedantry?

          • Earthly Knight says:

            You can’t do x at that exact moment regardless of your external circumstance is what was at dispute.

            Is it? No one, it seems to me, has mentioned “external circumstances” until just now. But fine. Suppose that I have just taken a large bite out of a tempeh burger and my mouth is full. Is it true that I no longer have the ability to talk? Or suppose that I am working through some algebra exercises, but am startled by a loud noise, and it takes me several seconds to regain my composure. Is it true that I lost my ability to do algebra problems in the interim? These are, under any reasonable understanding of the term, conflicts among internal circumstances, yet the ability still seems to persist even when I am temporarily unable to activate it. So it seems absolutely right to say that abilities can endure through at least brief periods of indisposition, including sleep.

          • James Picone says:

            I don’t know about you guys, but I’ve known at least one person who occasionally spoke Japanese in her sleep (native language: english) and once finished a level in a Sonic game in her sleep.

            I’ve had kinda-sorta conversations with her that almost made sense while she was asleep, too.

          • Mary says:

            No one, it seems to me, has mentioned “external circumstances” until just now

            You did. You discussed being on toilet, which is in fact an external circumstance, as if it were no different from the MENTAL conditions that were under discussion.

          • Mary says:

            I think it a reasonable difference is that the Francophone guitarist is regularly conscious every day before going to sleep,

            You presume exactly the point in dispute, that the prior consciousness makes a relevant difference, and is not in fact something fudged up to fix a rule that wasn’t well grounded in the first place.

            is connected to a web of social interaction, such that if the guitarist died peacefully in his sleep, his friends and family would still suffer grief,

            So you can forfeit your humanity by being a nasty git, or not being close enough to people that they will grieve when you die? How much grief is necessary to make you human? How can you determine it in advance to know whether killing this person is murder?

            Incidentally people grieve when children die before birth, so that makes your rule here broader than you think.

          • Brad (the other one) says:

            >and your claim about the foetus also proves too much, insofar as a putative future person which is currently in two parts, a sperm cell in one putative parent’s body and an egg cell in another, will also, if those people have sex, and a whole host of other things happen in an orderly fashion, be capable of playing guitar and singing in French, and yet we do not think that people have an ethical duty to maximize the number of potential future people transformed into actual people, and therefore an obligation to have sex with every fertile prospective mate at every opportunity.

            Ignoring the fact that I was under the impression that utilitarianism *could* result in ethical duties to maximize the number of people, I could not care less if my argument, according to you, proves too much, not in least because such a claim is totally fallacious.

            Perhaps if we lived in some grotesque Junti Ito story perhaps we’d have reports of sperm cells swimming out of containment tanks at sperm banks and seeking out errant females who to impregnate; perhaps we’d also hear of packs of rogue eggs floating through the air spying out lonely men to inflict parenthood upon. However, in the real world, an egg, left to it’s own devices, remains an egg and likewise with sperm.

            By contrast, if a woman gets pregnant, and 9 months later, gives birth, are suddenly surprised? All things being equal, a fetus following conception will grow to gestation and become an infant; much in a similar manner, a sleeping french guitarist will awaken and become an awake french guitarist. (If you say not all fetuses grow to term, I will remark some people die in their sleep.)

            If anything, the odd man out here is the cow; I can leave the cow alone for as long as I want, but it will never gain speech, literacy or the ability to speak french or play guitar. It’s almost like there’s some relevant categorical differences between humans and animals that forces us to prioritize kindness to our fellow man above animals. (How odd!)

            Allow me to make a tangent:

            In any case, my entire argument here, however, *is* totally useless. No, seriously, my entire argument above is waste of time.

            I am against abortion, really, not on any pedantic argument involving negotiating person-hood or ability or anything else. I am very simply against abortion because I am a Christian; I believe mankind was made by God in his own image; A general reading of the bible would indicate plainly that perhaps with the exception of justified capital punishment we are commanded not to kill our fellow man; it can be demonstrated bionically that a conceived humans prior to birth fall under the category of “mankind”; abortion is not justified capital punishment. (and while we have a can of worms with capital punishment, it is quite clear what the bible has in mind in capital punishment was not intended, as a rule, to justify infanticide, abortion, etc.)

            But I opened in an argument designed to persuade people who don’t believe any of those things and now here we are. So, time wasted. Sorry.

          • Winter Shaker says:

            Brad (the other one):
            Fair enough. I guess if you could demonstrate to me that
            a) a god exists,
            b) that god actually is the authority on questions of ethics, and
            c) the god has declared abortion to be wrong
            … then I’d have to agree with your position. But the first two of those premises have such a burden of proof to overcome; I’m glad that you agree that it is not reasonable to expect people to agree with your conclusion unless you can first persuade them of your premises.

            I’m curious though: if you became persuaded that either no gods exist, or no gods take a stand one way or the other on abortion, what would your position be then? Would you agree that there are morally relevant differences between non-sentient embryos and marginally-sentient foetuses on the one hand, and highly-sentient-most-of-the-time children and adults on the other hand?


            You presume exactly the point in dispute, that the prior consciousness makes a relevant difference, and is not in fact something fudged up to fix a rule that wasn’t well grounded in the first place.

            Okay, but it seems to me that if you’re going to have an ethics that is not at its deepest root level based on questions of suffering and wellbeing (which depend, so far as we can tell, on sentience), you will end up with something even more arbitrary, even if, human nature being what it is, it may be sometimes necessary to impose something more deontological to get there. If you think that prior consciousness (and the ability to feel pain etc) is irrelevant to questions of right and wrong, then I worry that our inferential distance may be too large to bridge here – or that we’re simply talking about completely different things but confusing the issue by calling them by the same name. Do you have a good argument for why we should care for something else more than sentience?

            So you can forfeit your humanity by being a nasty git, or not being close enough to people that they will grieve when you die? How much grief is necessary to make you human? How can you determine it in advance to know whether killing this person is murder?

            The ‘web of connections’ thing was one of several cumulative reasons why it appears that a sentient adult is on average of much greater ethical concern than an embryo.

            And I would say that, if someone is a nasty git whom no one will grieve, then you would be doing less evil in the world than you would be by killing someone who enjoys life and brings joy to all around them, but from a legal standpoint I would still want both to be treated equally as murder because of the colossal perverse incentives it would create if the legal system were to try to rank them. That is, I don’t think that all human lives are of equal value (by any reasonable, non-gerrymandered understanding of ‘value), but any legal system that is to be administered by humans should be constrained to treat all human lives equally, otherwise the temptation to play favourites would corrupt those involved in making and deciding the law into setting up a grotesquely unjust system in about three and a half minutes. Edge cases, such as the brain-dead, those with terminal illnesses who prefer a quick euthanasia to a slow, painful natural death (or even those who, after clearing Scott’s one hell of a psychiatric assessment, are declared to be perfect philosophers with a rational desire to end their life), and, of course, those who have not yet developed the sentience to elevate them to the status of full object of moral concern, should be treated as edge cases, and I would not propose the same rules apply to them.

            Indeed, I’d say that a society that admitted that some deaths are a greater loss than others, but nevertheless had its legal system set up to treat people’s lives as of equal value, would be a pretty good example of one of those ‘you can actually get closer to the best consequences if you superimpose a deontological-flavoured rule on top of your consequentialism’ situations.

            people grieve when children die before birth, so that makes your rule here broader than you think

            Sure, but what they are grieving is the loss of an opportunity to bring up a child that they were looking forward to getting to know, rather than the death of someone they had already come to love. I can’t think of a way to get precise numbers, but I’d be very surprised if people were as affected by a miscarriage as they were by the death of, say, their ten-year-old child.

            Also, people who are looking forward to having children of their own can also suffer grief on discovering that they are entirely infertile – unable to even have a miscarriage because they cannot conceive in the first place. And from the outside the [thing that is being grieved for] in the case of someone who doesn’t get to have a child because they miscarried looks like it would at least plausibly belong closer to the [thing that is being grieved for] in the case of someone who wants a child but discovers they are infertile than it does to the sentient child who dies at the age of ten. If someone wanted to argue that the embryo or foetus should be given the same moral worth as the ten-year-old, rather than they hypothetical longed-for child that you can’t actually conceive, they’d need to give me some persuasive reason for that.

          • Brad (the other one) says:

            >I’m curious though: if you became persuaded that either no gods exist, or no gods take a stand one way or the other on abortion, what would your position be then?

            What is ethics? Isn’t just how we correctly relate to each other? but what is correctly relating to each other? is it not what is beneficent? and what is beneficence? is this not a value judgment? And what exactly is valuable, in a universe where all men die and are gone forever?

            All things men value are based in how such things relate to them. But the dead cannot relate to anyone or anything, and all men die. And so
            I state in such a case nothing would hold lasting or permanent value. And since nothing would have permanent or lasting value, (since all men die, necessarily, due to entropy) How could any choice be better than another? Vanity of vanities, all is vanity.

            But people cannot live like that. So – I assume my position on abortion would be what it is for most people: Whatever is most convenient and beneficial to their own selves in the short term.

            >Would you agree that there are morally relevant differences between non-sentient embryos and marginally-sentient foetuses on the one hand, and highly-sentient-most-of-the-time children and adults on the other hand?

            In such a universe there is only one morally relevant difference: better you than me.

  11. onyomi says:

    Regarding whether or not to treat autism as a “disease” or “disorder,” and whether or not “curing” autism would be a net positive, due to elimination of suffering, or a negative, due to elimination of a certain neurotype:

    Aren’t many or even most psychiatric disorders just extreme/obtrusive manifestations of traits/tendencies everyone has?

    Like with bipolar: everyone has ups and downs, but when they get extreme, you have bipolar.

    Anxiety: feeling some anxiety is normal and adaptive; feeling crippling anxiety all the time is not.

    OCD: being a little obsessive about some things can be productive, and most people can get really into something, maybe even a little compulsive; similar with thoughts: everyone worries occasionally, but when a person is menaced by constant intrusive thoughts it becomes a problem.

    etc. etc. In other words, most mental disorders are not like a virus you have or you don’t, or a switch that gets flipped or does not: rather they are like having certain control knobs, which exist in everyone, turned way up or way down beyond their usual, adaptive levels.

    Now you might say “if we eliminate bipolar, then maybe Kurt Cobain would still be alive today… yet maybe he also wouldn’t have created the great music he did.” Both may very well be true. But if we assume Cobain could either have a stable mood or be a musical genius, but not both, then doesn’t the choice rightly belong to him and his family and friends? Wouldn’t it be obviously ridiculous to say that it’s wrong to spend research money on mood stabilizers?

    • onyomi says:

      Also, though we might worry a “cure” could medicate a few geniuses into mediocrity, there is also the not insignificant possibility of medicating some non-functional people into genius.

  12. Name says:

    RE: “I am generally pro-choice. As best I can tell fetuses have less personhood than cows, and I had a cheeseburger for dinner last night.”

    Do you have a post where you have explained your views on population ethics in more detail? I have a hard time reconciling donating to charities aimed at increasing the number of people who will exist in the future with being pro-choice.

    • Anon says:

      > donating to charities aimed at increasing the number of people who will exist in the future

      Are there any for which this is an explicit goal? “stop people from dying” is not isomorphic to “cause more people to exist” under many plausible moral axioms, especially when “stop people from dying” comes with a lot of “stop people from suffering horribly and imposing huge costs on their communities without actually dying”. Deworming in particular, which is the goal of 2 of the 4 top charities recommended by GiveWell, has only minor effects on mortality but major effects on quality of life.

      Also, evidence has always been that decreasing child mortality also decreases eventual birthrates; it is almost certain that AMF, for example, will lower the total number of lives ever lived (most of the counterfactual no-longer-manifesting lives being those which would have been extinguished after a handful of years of suffering).

    • Anon says:

      Isn’t the implicit assumption by pro-choice utilitarians that a child you have now is one you probably won’t have later? The limiting factor for most parents isn’t how many children they could have (For men irrelevantly high, for women, maybe at least 20?) but rather how many children they want to have. Aborting a fetus thus doesn’t actually reduce the number of children you have, but pushes around the dates, and possibly makes the children, parents and relatives happier and more prosperous through better timing.

      There are obviously extreme positions which require having as many offspring as possible, and these would preclude abortion except in certain eugenic cases, but that’s a very rare position to argue, and almost non-existent to practice.

      • Name says:


        RE: “Are there any (charities) for which this is an explicit goal? “stop people from dying” is not isomorphic to “cause more people to exist” under many plausible moral axioms”

        Yes. See any charity with the goal of reducing existential risk, such as MIRI, which Scott donates to.

        RE: “Isn’t the implicit assumption by pro-choice utilitarians that a child you have now is one you probably won’t have later?”

        Is there any data on how often that’s the case? If it’s 100% (which it’s clearly not), then it’s easy to justify being a pro-choice total utilitarian. But it doesn’t have to go very far below 100% for it to be hard to justify. 87.5% would mean the average abortion removes ~10 years of life.

        • Anon says:

          … What? “Stop everyone from dying” is *definitely* not the same as trying to maximize the number of people who will exist in the future. Yes, it might be a side effect, but also might not. That’s why I asked about charities for which it was an explicit goal.

          • Name says:

            It is an explicit reason that people give for trying to reduce existential risk. But I see Scott has commented that he doesn’t donate to MIRI for that reason.

        • mca says:

          “RE: “Are there any (charities) for which this is an explicit goal? “stop people from dying” is not isomorphic to “cause more people to exist” under many plausible moral axioms”
          Yes. See any charity with the goal of reducing existential risk, such as MIRI, which Scott donates to.”
          Charities with this goal want to see the species (or its predecessors or whatever) extend many generations into the future. Wanting to bring about the continued existence of the species is a very different goal from just increasing the number of people.

          “RE: “Isn’t the implicit assumption by pro-choice utilitarians that a child you have now is one you probably won’t have later?”

          Is there any data on how often that’s the case? If it’s 100% (which it’s clearly not), then it’s easy to justify being a pro-choice total utilitarian. But it doesn’t have to go very far below 100% for it to be hard to justify. 87.5% would mean the average abortion removes ~10 years of life.”

          Unless you address the “not very important moral agent” point, this argument, as others have noted, also implies that utilitarians would have a duty to maximize their potential fertility. Maybe you think it does have that implication, in which case it would seem to be a strike against utilitarianism, but I don’t think you can argue that utilitarianism is inconsistent with being pro-choice without at the same time arguing that it is also inconsistent with extreme pro-natalism.

          • Name says:

            RE: “Wanting to bring about the continued existence of the species is a very different goal from just increasing the number of people.”

            What do you accomplish, ethically, by making a species last longer that is different from bringing more happy people into existence? Do “species” have a moral value that people do not?

            RE: “I don’t think you can argue that utilitarianism is inconsistent with being pro-choice without at the same time arguing that it is also inconsistent with extreme pro-natalism.”

            I agree.

          • mca says:

            “What do you accomplish, ethically, by making a species last longer that is different from bringing more happy people into existence? Do “species” have a moral value that people do not?”

            Everyone bringing as many people as possible into the world right now would run into Malthusian constraints, which is not an issue with making the species last longer. (Also I personally am agnostic between pro and anti natalism from a utilitarian standpoint.)

    • Scott Alexander says:

      I don’t think I donate to charities that exist the future population, except as a side effect of other good things. Nor would I.

    • RCF says:

      “I have a hard time reconciling donating to charities aimed at increasing the number of people who will exist in the future with being pro-choice.”

      If you have some reason for thinking that they are contradictory, perhaps you should present it. As it stands, I see your statement as saying more about your analytical skills than about the actual subject matter.

      • Name says:

        RE: “If you have some reason for thinking that they are contradictory, perhaps you should present it.”

        If you take a total utilitarian view, then human extinction is really really bad not just because of the people it kills, but because of all the people after that point that would not come into existence with lives of net positive utility. In fact, the number of people prevented from existing adds up to a way higher loss of total utility than the people who die in the extinction. This is a claim people often make to argue that reducing existential risk is far and away more important than any other ethical thing you can do.

        If this is the right way of looking at things, then it seems like it would imply that the marginal abortion is very bad. If you abort a fetus, you are reducing total utility by the ~80 years of existence that person would have had. That’s worse than killing a 40 year old adult, where you’d only reduce total utility by half a human lifespan.

        RE: “I see your statement as saying more about your analytical skills than about the actual subject matter.”

        Then please explain. This is why I asked the question – population ethics is really confusing.

        • RCF says:

          “If this is the right way of looking at things, then it seems like it would imply that the marginal abortion is very bad.”

          That does not necessarily follow, but the question of whether it follows is not the central flaw in your thought process. Even if there is a strain of thought that leads to two different conclusion, that does not in any way make accepting one and rejecting the other difficult to reconcile. Your argument basically comes down to:

          if X then (A and B)
          not (A and not B)

          This makes no sense.

  13. “If everyone gets a basic income, autistic people who want to spend it on getting the care and support they need to remain autistic could do so without costs to anybody else.”

    TANSTAAFL. Productive people still have to work and pay taxes to provide that basic income.

    • swerj says:


    • Justin says:

      While, yes, obviously, the various models of basic or guaranteed income have a base level of costs, it doesn’t necessarily have additional costs above and beyond the current models of welfare in use, so don’t worry too much about your own pocket. People as gung-ho capitalist as Milton Friedman have proposed guaranteed minimum income as a way to get rid of all other welfare systems and even the minimum wage.

      • Nathan says:

        While I’m not going to claim to be the world’s foremost authority on Milton Friedman’s opinions (we have a regular commenter who probably can, though), I think that he advocated a Negative Income Tax as opposed to a GBI, and I also think that that proposal was in his view something of a “second-best” solution that was at least better than the welfare system as it existed. As far as I know, Friedman’s ideal system involved no transfer payments.

        • Tibor says:

          Well, the negative income tax, if I understand it correctly, is more or less the GBI combined with an incentive to work. In the absence of a minimum wage everyone who is healthy enough to function normally can find a job. The negative income tax is meant to be progressive in the way that it always pays off to have a better job…but you get some money even if you make $0 an hour.

          Friedman argued that it would be a good replacement for the current (extremely messy, burdened with huger overhead) welfare system, thus making it cheaper while simultaneously giving more of both the actual welfare and agency (you decide what you spend your money on) to the recipients. My impression is that most GBI proponents do not wish to get rid of the current welfare system though, so this is another difference.

          I am not exactly sure what Milton Friedman’s stance on negative income tax was, whether it was “let us do this now and eventually, once the society is rich enough, we won’t need any state-organized welfare” or “let us do this now and keep it for some 10-20 years to make the transition to no state-organized welfare smoother, if we tune down the state in most areas, we are ready to get rid of state-organized welfare today and be all better of by doing so”.

          • brad says:

            A couple of points:
            1) I’m under the impression that most BI supporters do, in general, want it to replace welfare.

            The sticky bit, which keranih brought up elsewhere in this thread, is what to do about the “deserving poor” whose needs are greater than can be provided for BI. Specifically relevant to this thread is institutionalization which costs far more than any realistic BI would be.

            2) I don’t think you’ve got the differences between a BI and negative income tax quite right.

            It sounds like you are thinking of BI as a flat top up — i.e. if you make less than $15k we give you $15k – income. That would indeed have pathological incentive problems and a negative income tax is strictly superior.

            A BI on the other hand is if you are in the qualifying group (which is subject to debate, but one possibility is: adult, non-institutionalized citizens) you get a check for the BI. No income dependence or proof of “deservingness” or “need” applies. This kind of BI doesn’t not have any convexities where the recipient is worse off from earning a marginal dollar.

          • Tibor says:

            brad: I would certainly prefer GBI over the current system. I would not support a proposition to institute it though unless it eliminated the current welfare system at the same time. Same with negative income tax.

            You were right, I thought that GBI means “if you make less than X, you get X”. This way, I am not sure whether it is better or worse then the negative income tax, both seem like good approaches to rationalize the current welfare system. On the other hand, negative income tax encourages working unlike the GBI. You might end up with a lot of people deciding that GBI and no work is a pretty good deal, which could result with the system being unbearable. Negative income tax is supposed to give you the bare minimum if you don’t work at all and let you find a job, since you can compete with any price (it does not work with an instituted minimum wage of course). Of course, you could set the GBI in such a way that living on it alone is not desirable enough for most people, so only a few people would choose not to work at all and you could sustain it then.

            I am not sure whether the “deserving poor” category is all that big. Basically it only covers genetic health problems. You cannot get insurance if the insurance company knows you will cost it more than you will pay. This also includes institutionalization. But other than that, these high costs can be covered by setting up insurance.

            The question is what to do with someone who did not buy the insurance and then found himself in a position where cannot pay his medical bills. One answer is “his problem, he was reckless, now he has to pay for it”. There is some merit in that. Consistently punishing irresponsibility makes people more responsible. On the other hand, not even the most hardcore libertarians would probably let someone bleed at the doorsteps of their hospital had it come to that. Of course, you can treat those bleeding people and then make them seriously indebted. This seems to me personally like a good middle ground between “no insurance and no cash – you can die for all I care” and “we have to give the best possible care to everyone because life is sacred”. But as you pointed out, this does not work with institutionalization. If someone has an accident with the result of requiring life-time medical care and no chance to ever work again, he will not pay you back, so if he has no insurance you are left with “let him die, he should have bought insurance when he was fine” and “well, let us treat him even if this increases the incentive for others to be reckless and not buy health insurance”.

            So the question is how much money do (inborn health issues+reckless people who end up needing life-long medical care) actually cost. If it is not much (as compared to the economic power of the population), one might solve it with private charity alone (although I doubt charity for reckless people would gain a lot of support), especially since with a more sensible welfare system (negative income tax or GBI) you can reduce taxes and leave people with more money at their disposal (which also means it is likely to be used more efficiently thus leaving the people with even more money). If it is a big proportion, private charity may not be able to cover it anyway.

      • Jon Gunnarsson says:

        It’s not a logical necessity, but in practice a universal basic income would almost certainly be much more expensive than the collection of mostly means-tested welfare systems that currently exist, due to the simple fact that you’re paying everyone, instead of just a selected portion of the population, so unless the basic income is supposed to be much lower than current welfare, the whole thing is going to cost more. Yes, there would be some savings from cutting down bureaucracy and removing some bad incentives, but not nearly enough to make up for the lack of means-testing.

    • Cadie says:

      There are a number of different ways to implement basic or guaranteed income, but nearly all of them involve using them as a replacement for some or all of the other poverty-alleviating benefits programs. So the taxes that are currently going towards housing assistance, food stamps, and the like (and paying for all the bloated bureaucracy involved in those programs) are instead going into direct money transfers.

      That isn’t enough to pay for a real minimum basic income that would be enough to live on, but it pays a large portion of it. And it doesn’t create negative incentives around part-time or low-wage work the way the current welfare programs do. If you make too much, you get cut off, so it actually doesn’t pay to work if you can’t work full-time and/or at a high wage. With basic income, people who are only capable of working part-time in entry level or heavily supervised jobs can do that without losing their housing, medical care, and other benefits. So they end up paying more tax with basic income than without.

    • “everyone gets a basic income” doesn’t mean no one works.

    • Scott Alexander says:

      Yes, but autism in particular would not be costing those people anything. They would be giving the money regardless, and recipients could choose to spend it on autism care or other things that they wanted.

    • RCF says:

      You are comparing remaining autistic with UBI to not having UBI, while Scott is comparing remaining autistic with UBI to not remaining autistic with UBI. That is, you are ignoring the constraint that we are operating within the hypothetical of having UBI.

  14. suntzuanime says:

    Which do you think is more likely? That soon biologists will discover a molecular cure for autism? Or that soon politicians will discover a cure for the systemic issues that cause poor people who can’t stand up for themselves to be maltreated and abused?

    They discovered a cure, but the Food and Drug and Un-American Activities Committee refused to approve it.

  15. Elizabeth says:

    No-cure, “not a disease” is pretty central to most autistic self-advocacy I’ve seen. There’s an increasing acceptance there of autistic people who themselves want to be cured.

    “Take someone who can remain stable as long as there are no unexpected loud noises, and make him share a room with a guy who screams at the top of his lungs every couple of minutes for no reason.” This has been a big problem at large gatherings of autistics. “Conflicting access needs.”

    • Randy M says:

      “No-cure, “not a disease” is pretty central to most autistic self-advocacy I’ve seen.”
      Sure, but being able to advocate for oneself requires a certain level of competence. Presumably people like those Scott described may have other opinions were they able to clearly express themselves.

  16. Justin says:

    Not to put too fine a point on it, but footnote number three uses literally the same justification that was used by the eugenicists around the world in the early part of the 20th century when they were forcing sterilization (and, eventually, under Aktion T4, “forced euthanasia”) upon the “feeble-minded”, a population not insignificantly made up of people who would now be diagnosed as autistic even by the more stringent definition of the word.

    • Vanzetti says:

      Hitler loved dogs, therefore loving dogs is evil.

      • Justin says:

        Applying eugenics to the disabled wasn’t even Hitler’s idea, though. His cronies mostly got it from people that were trying the same thing in the United States. Besides, I’m pretty sure eugenics is evil on its face, regardless of its connections, I’m just talking about optics more than anything else.

        • Anon says:

          Scott almost certainly would disagree with the statement “eugenics is evil on its face, regardless of its connections” (Unless I’m wildly misinterpreting what it means).

          Everyone here realizes the nazis were bad people and they advocated for eugenics, and many other groups at the time used eugenics in both coercive and pointless ways. Some people just don’t want to throw the baby out with the bathwater.

          • Justin says:

            Yeah, and those people scare me. That’s the one baby I would have been fine with using prenatal screening and selective abortions on.

          • Anon says:


            “Genetic engineering to cure diseases is eugenics!” Okay, you’ve got me there: since eugenics means “trying to improve the gene pool” that’s clearly right. But what’s wrong with eugenics? “What’s wrong with eugenics? Hitler did eugenics! Those unethical scientists in the 1950s who sterilized black women without their consent did eugenics!” “And what was wrong with what Hitler and those unethical scientists did?” “What do you mean, what was wrong with them? Hitler killed millions of people! Those unethical scientists ruined people’s lives.” “And does using genetic engineering to cure diseases kill millions of people, or ruin anyone’s life?” “Well…not really.” “Then what’s wrong with it?” “It’s eugenics!”

            That’s Scott’s viewpoint on this topic, more or less. Mine too, for that matter. The way you do it matters, but eugenics isn’t, wholly in and of itself bad. Rather, it’s an idea so beautiful (A world with no diseases, everyone wins the genetic lottery!) people were willing to pursue it in terrible, terrible ways. No idea is so good that every application of it is also good.

          • Justin says:

            Well, given that they’re not all afflicted with one, at least autistic people wouldn’t be affected by “a world with no diseases”, I guess.

          • Anon says:


            I can’t help but feel you’re arguing in bad faith. Replace the term disease with “Biological condition with results in suffering for a substantial portion of individuals which have it”.

            Scott even addressed the exact same point “Is autism a disease” in the article, linking to the same thing I just did.

            Edit: Unless you’re saying that not all autistic people suffer, and thus they wouldn’t be affected by eugenics. That’s a valid point. There’s no need to cure autism in high functioning cases, and in fact it probably wouldn’t even be desirable often. Scott is just saying not all autism is this “Quirky shy nerd” type, and pretending that it is does a great disservice to people who actually have a condition which causes them great suffering.

          • Justin says:

            People who wouldn’t have “suffered” absolutely would be affected by using eugenics to eliminate autism.

            It’s a neurological divergence with a genetic basis that, by all indications, exists before birth and, by all indications, it’s impossible to tell how that difference will manifest itself until it actually does so, so the only even theoretical methods for eliminating it would be with prenatal screening resulting in aborting autistic fetuses or with preventing autistic people from procreating. So-called “high functioning cases” would be babies thrown out in that bathwater. While I’m certainly relatively “high functioning”, I would have never have been born, which is quite an effect on my life.

          • DrBeat says:

            How can you make the “This is bad because it would have resulted in me being aborted” argument, without also being anti-abortion in general?

          • Anonymous says:


            I think you could take this a step further:

            “If anything in history had been different, I would not have been born. Therefore, the laws and social customs that have existed were exactly the right ones, and existed for exactly the right amount of time.”

          • Justin says:

            I can make that argument in this context because the only reason given for me having been aborted would be that I would be born me, which I can take issue with personally, whereas being aborted in general does not come with such a me-specific reason, so I can’t really take it personally. I oppose abortion selective based on the specific potential person being aborted, not abortion selective based on the general state of a person’s potentiality.

          • Whatever Happened To Anonymous says:

            >I can make that argument in this context because the only reason given for me having been aborted would be that I would be born me

            Well, yes, but that’s because you being born you would have a good chance of being a significant additional burden (general autistic you, I make no claims to knowing your specific situation and history) on them. If you’re going to prevent abortion on those grounds, you’d be narrowing down the permitted reasons significantly.

          • Max says:

            “Everyone here realizes the nazis were bad people ”

            Actually not. Nazis were people. Mostly normal, good people. Their ideology led some of them(not all) to commit acts which is considered “bad”. That does not make them “bad” or “evil”

            You under same circumstances/time period/culture would do same thing or worse

            Sure there were true psychopaths and deranged people among them – just like there are among every other group of humans

    • Montfort says:

      Admittedly, I am not exactly a scholar of historical eugenics practice, but you seem to be missing a rather large difference here. Scott explicitly mentions that the support would be withdrawn only if a cure were freely available and refused. I think I would’ve heard about it if the Nazis had a way to cure all the “feeble-minded.”

      I’m not sure this will actually make the idea much less repellent to you, but it is certainly not “literally the same justification” as used for T4, it’s more like the same justification Medicaid uses when deciding which treatment options to cover.

      • Justin says:

        When I said that it was literally the same justification, I was referring to the cost to other taxpayers, so only the justification, not his proposed implementation. There’s no actual difference in justification. The Nazis literally made propaganda posters about how much an individual disabled person cost German taxpayers.

        • Montfort says:

          If I were to accept your argument here, we would be forced to conclude that approximately every governmental budgeting decision used the same logic as that which justified T4. Which is, in a sense, true – all states have a finite amount of money and so must prioritize some things over others. But I hope you can see how meaningless that statement is.

          • Justin says:

            Yes, but extremely few governmental budgeting decisions are explicitly about the disabled, and the governmental budgeting decisions that are about the disabled could use a lot less emphasis on the cost to taxpayers — I survived the mayoralty of Rob Ford, who emphasized the cost to taxpayers of every decision so much that he only ever referred to the people of the city as “taxpayers”, even in contexts where it sounded comically absurd — and a lot more emphasis on the real world effect they have on disabled people.

          • Airgap says:

            “See those taxpayers over there? Do you think we could buy some crack from them?”

    • Soumynona says:

      You’re missing or ignoring a nuance. Scott says that people with disabilities should be supported but questions whether that should extend to disabilities which are curable and kept voluntarily.

      This is an actual quote from Scott’s argument:

      Of course, helping the needy is exactly the sort of thing the government should be doing, and right now the government ought to do whatever it takes.

      This is literally what the Nazis thought? No wonder they lost the war, those bleeding-heart namby-pamby hippies.

      • Justin says:

        You’re missing or ignoring that, as I previously clarified, I’m speaking in more limited terms, specifically, I’m only referring to the justification used in forming the thoughts laid out in the third footnote.

        So, no, that isn’t what the Nazis thought, but the specific justification used for justifying the need to solve the supposed problem, that of the lifetime cost to taxpayers of keeping such people alive and well is literally the same as that which was used by both the Nazis and the Americans they took their ideology (on this subject) from.

        • keranih says:

          Right. If the social attitude had been that it was strictly the family’s responsibility to take care of the disabled, (or maybe charities), and that the government didn’t have a vital role to play in taking care of them, then so if they ran crazy or died in the gutters it wasn’t a *community* issue to solve, then the idea of The State rounding them all up and euthanizing them would not have been taken seriously.

          It was The State Solves Problems; This is A Problem, The State Shall Solve This equation that gave the power of a whole nation (or most of it) to the inhumane excesses.

          • Mary says:

            “Everything inside the state, nothing outside the state, nothing against the state.”

            That is the totalitarian definition of totalitarianism. Yes, the term has picked up some unpleasant connotations of it, but the root is that; the unpleasantness is the fruit.

  17. Helldalgo says:

    I’m autistic, and my knee-jerk reaction is “No, don’t cure it – I have spent a lot of time cultivating a social identity that optimizes the positives of autism and alleviates the negatives.” My true rejection of the idea, I think, is simply a sunk-cost fallacy. All that time spent learning to live with autism feels like it would be nullified by the existence of a cure.

    Of course, that’s ridiculous. That’s like saying the effort put into building horse carriages 200 years ago was nullified by the existence of cars.

    On the grounds that people should be as free to choose as possible: Yes. I agree. No argument there, except for some logistical nitpicks about choice that you briefly addressed in the post.

    The thing is…I enjoy being weird. I have to consider the possibility that I only enjoy being weird because “normalcy” was not available. Or that being weird has been granted high status in certain intellectual circles. Circles like the ones I’d like to be in. On the other hand, I did suffer as a child and I suffer (slightly less) as an adult. The other day, I was walking with my spouse, and a car honked at me. Without thinking, I turned around, screamed an obscenity, and spent the rest of the evening on the verge of a panic attack. I constantly put non-food things in my mouth as a form of “stimming.” Side note: it’s not pica, I don’t eat the things.

    As a child I was virtually friendless. My mother had to spend hours with me on social roleplaying exercises, simply so that I could function with my peers. I could not wear certain articles of clothing that were ubiquitous as a teenager, because of sensory issues. I could not, and cannot, attend crowd events unless the audience is likely to be quiet, or I can slip away when I become anxious.

    I could go on, but you know the story. I suppose that if I really think about it, I would like to see a cure.

  18. Douglas Knight says:

    Have you used the “against against” construction before? It feels familiar. Maybe something analogous? I put it into google and found a New Yorker piece entitled ‘Against “Against [X]”

  19. Wrong Species says:

    So would it be more utilitarian to “cure nerdiness”(assuming the net effect would be less innovation and more happiness among current nerds) or keep the status quo? How would you even try to make that kind of calculations?

    • TrivialGravitas says:

      He answered that in the footnotes.

      • Wrong Species says:

        He didn’t answer so much as say “I’m going to arbitrarily put a line somewhere”. I just want to know how a consistent utilitarian would go about finding the answer.

        • JBeshir says:

          I think the position he put the line is not so much “arbitrary” as “based on my assessment of costs and benefits, the benefits become greater than the costs at this point”, which is roughly how someone who is consistently utilitarian would do it.

          Utilitarianism generally shouldn’t look consistent in any greater sense; numbers, scales, and degrees matter to consequences, and situations which are analogous to each other will end up being handled differently because the estimates of the sizes of the factors involved are all different. And since strong evidence is in short supply a lot of the time this is going to involve fuzzy estimation.

          (Corollary: If your position *does* look consistent between analogous situations with wild variations in the relative sizes of different effects, it’s very likely bad utility-wise in some of the cases.)

          This tends to feel very unsatisfying. Probably the only way I could see you improving on it is by making a more concerted effort to acquire strong evidence, though.

    • Anon says:

      Calculate the average happiness of normal people, then calculate the happiness of nerds.

      Calculate the marginal impact on the world of an additional average normal person (Mean, not mode or median) and the impact of an additional average nerd (Again, mean, not mode or median).

      Keep in mind the biggest impacts may be achievable with a relatively small number of nerds, making more nerds marginally less useful.

      iff happyNorm + maginalimpactNorm > happyNerd + maginalimpactNerd, reduce the number of nerds.

      In the opposite case, increase the number of nerds.

      Edit: Comparing happiness to external impact is a classic utilitarian problem. If you’re just saying “How can we do that?”, this is a much less specific and more basic question than I thought. I have nothing new to contribute to that particular question, though it is a good one.

      Edit: By “increase/reduce the number of nerds”, I mean prefer creating (Non)-nerds, or turning one into the other, not just like, killing people or something. I hope this was obvious.

    • Scott Alexander says:

      The most hedonistic-utilitarian thing to do is to convert everything to some computational substrate that just sits around experiencing pure joy all the time; I don’t think such a substrate could be reasonably described either as “autistic” or “neurotypical”, except maybe in the very old Bleulerian sense of “autistic”.

      The most preference utilitarian thing to do is – complicated, because nonexistent people can’t have preferences. I think it would depend on the preferences of existing people, but I’m not sure it’s fair to let the neurotypical majority use its larger size to sway the vote. I don’t think preference utilitarianism has a single strong answer to this question. I usually make it on not-completely-utilitarian grounds about wanting to strike a balance between variety and happiness, but this is admittedly arbitrary.

      • Vox Imperatoris says:

        I’m not sure it’s fair to let the neurotypical majority use its larger size to sway the vote.

        Okay, you’ve lost me here.

        Isn’t the whole idea of utilitarianism that each person shall count for one, and no one for more than one? It seems like if eliminating autism satisfies more people’s preferences, a utilitarian should do it.

        Disclaimer: I am not now nor have I ever been a member of the utilitarian party.

        • jeorgun says:

          Emphatically not— otherwise the concept of a utility monster couldn’t exist.

          (Or, if you find the “utility monster” framing distasteful— most utilitarians agree that the average human’s preferences are more important than the average rat’s)

          Not that that has much to do with the specific case of neurotypicality, but still.

        • Jon Gunnarsson says:

          Utilitarianism (at least in the classical Benthamite tradition) does count everyone as one. However, it doesn’t treat preferences as binary, but also takes into account their intensity.

          Let me illustrate by way of example. Suppose there are a hundred Nazis and ten Jews. The Nazis want to the Jews to be killed, the Jews prefer not to be murdered. In a democracy, the Nazis outvote the Jews and murder them. To a very crude approximation, this is kind of what actually happened.

          But Nazis only gain 1 util per murdered Jew, while a Jew loses 100,000 utils by being murdered. So in our example, murdering all the Jews gives 100*10*1 – 10*100,000 = -999,000 utils, which is why utilitarians oppose the Holocaust.

          (However, as you may have noticed, this calculation is sensitive to the number of Nazis, which is why Robin Hanson has remarked that the problem with the Holocaust was that there weren’t enough Nazis.)

          • RCF says:

            “Robin Hanson has remarked that the problem with the Holocaust was that there weren’t enough Nazis.”

            Assuming that the utils that Nazis experience from killing Jews is dependent on the absolute number of Jews, rather than the percentage of the population that Jews make up.

          • David Kinard says:

            yeah. That is why utilitarianism isn’t flawed. Assigning numbers to the subjective values of degrees of happiness or other sense of what makes a human life worthwhile is flawed. Those things may be ultimately reducible to numbers, but current attempts to approximate them are based on ridiculously simplistic measures.

      • Buck says:

        FWIW, it’s totally not obvious that the best thing to do from a hedonic utilitarian perspective is to convert everything to that computational substrate.

        Wait, you don’t think nonexistent people have morally relevant preferences? Why do you care about human extinction then?

        • PDV says:

          No, it’s pretty obvious. Arguments that it’s not the hedonic optimum just look like bad faith, trying to justify why this value system is compatible with things people would actually want, rather than honestly determining the consequences of the value system.

          And we care about human extinction for the obvious reason: People alive now prefer for humans to keep existing and for their values to be promoted in the future, even after their own deaths.

        • Wait, you don’t think nonexistent people have morally relevant preferences? Why do you care about human extinction then?

          Currently existing people want people to exist forever; so people should exist forever.

          Currently existing people may even want us to change the world to match the preferences of (specific) counterfactual people — but this version of preference utilitarianism says that we should improve the world relative to non-existent preferences because we actually existing people want to, not because changing the world to better match non-existing preferences is intrinsically good.

      • Jaskologist says:

        I’m not sure it’s fair to let the neurotypical majority use its larger size to sway the vote.

        I’m picking at a tangential nit here, but what a nit! The majority doesn’t “sway” the vote, they win it. If that’s problematic, then it’s really time to rethink democracy.

        Disclaimer: I am not an NRX, am generally pro-democracy.

        • keranih says:

          If I was just appointed High Queen of The Universe, then this would all be moot, we wouldn’t waste time on silly votes, and we could go back to grousing about the new season of TWD.

        • RCF says:

          I think that Scott, along with a large portion of the populace, opposes pure democracy (that is, treating democracy as a terminal value that overrules any other moral principle).

      • HeelBearCub says:

        “but I’m not sure it’s fair to let the neurotypical majority use its larger size to sway the vote”

        Isn’t an important metric here whether non-neurotypical people would prefer to a) have children, and b) that their children be non-neurotypical?

        On a guess, autistic people are going to score much lower on both those measures, so from a preferences point it seems like there should be less utilitarian “points” given to NNTs however you count.

    • Matt says:

      Arguably, curing nerdiness would negate utilitarianism, so the utility of utilitarianism would have to be factored in.

  20. blacktrance says:

    Everyone knows nerds are less happy than normals, at least in high school.

    I would be surprised if nerds were significantly less happy than normals in high school. Certainly some of them are unhappy, but in my experience, my nerdy friends and I have not just been happier than the average normal, but happier specifically because of our nerdy traits. Analytical thinking, a lower desire for social interaction, noticing “social reality”, etc, tend to contribute to happiness. So if anything, I’d guess that modifying people to be nerdy would make the population happier on average.

    • PDV says:

      [Citation Needed]

      I think this is at best atypical, and more likely delusional. ‘Noticing “social reality”’ in particular seems to me to be an obvious hindrance to happiness.

      • Whatever Happened To Anonymous says:

        >and more likely delusional

        So they only thought they were happy?

      • blacktrance says:

        Noticing “social reality” gives you the opportunity to create alternatives to it, where normals would think of it as just the way things are.

        • Mary says:

          Of course, by the same token, alternatives can make you unhappy by contrast, whereas if you treated them as “the way things are” they would be a lot easier to deal with.

      • Chalid says:

        I’ve never seen any evidence one way or the other (nor have I looked), but in the absence of evidence I’d think nerds should be assumed to be as happy as anyone else on average. (Assuming the definition of nerd is reasonably rounded and doesn’t select only the “negative” traits, of course.)

        We as a group may believe that we have unique special burdens but most other people believe that sort of thing about themselves too.

        Certainly there are communities and schools where nerds would be worse off but there are others where they are better off.

    • Wrong Species says:

      Quick sanity check: Almost everyone here can reasonably be described as nerdier than the general population. From the comments, do you get the impression that we are happier or more miserable than the general population? Obviously that’s not the scientific way of looking at it but it boggles my mind that you would assume nerds are happier, when everyone else assumes the opposite.

      • Nornagest says:

        I’d say more miserable, but that might be outgroup homogeneity talking, or it might be that nerd culture is more open about being miserable and that leads to availability bias.

      • blacktrance says:

        There’s the selection effect of this being in part a psychiatry blog. The rationalist community is also more mentally ill than average, which contributes to unhappiness, so it could come out behind overall. But the effect of nerdiness is likely positive – nerds who aren’t mentally ill are, in my experience, happier than normals. And there are a lot of unhappy normals, too.

      • Chalid says:

        I’d say the population here strikes me as less happy than the general population if you control for (what I imagine to be the) education, income, etc. of the group, but more happy than the general population. Nerdiness of course increases your education and income.

        I also would guess there’s a connection between age and your perception of nerd happiness.

    • houseboatonstyx says:

      I would be surprised if nerds were significantly less happy than normals in high school. Certainly some of them are unhappy, but in my experience, my nerdy friends and I have not just been happier than the average normal, but happier specifically because of our nerdy traits. Analytical thinking, a lower desire for social interaction, noticing “social reality”, etc, tend to contribute to happiness.

      Anectdata: During my nerdy high school years I was most hours very happy. Being rejected from social things stung with embarassment, but as soon as I got home and opened a book — the world disappeared in hours of happy reading (or geometry or something). Whatever had happened outside, the home time was not affected. The world of the books was always there. Being alone on prom night was just as enjoyable as on any other night

      Then in an anthropology class I read about phatic small talk and body language and rapport and all that, and got hit on the head, and woke up with the social side working and the reading side not working. Stuck on the social side. At home it was like I was still hooked to the outside people, thinking only the thoughts I would be able to say to them. Boring.

      I’m sure the jocks and cheerleaders and other normal kids didn’t know what they were missing. But still their lives must be about status and stuff all the time, no world of home to dive into just any time you wanted. What we nerds liked was always there, always open to us. We could change our experience deliberately, just by which book we opened. We were driving our own car; they seemed just reacting, pulled randomly by outside stuff. We could decide which world we wanted to go into, each hour, no hurry deciding — in what now might be described as a meta state?

    • Who wouldn't want to be Anonymous says:

      In addition to being a huge nerd, I was also an athlete in high school so I got a pretty good look at the two 1980’s-comedy-diametrically-opposed groups in real life. I would say that, in my experience, the nerds and jocks were equally happy in high school. The same for college. (Despite my personally being somewhere between very and extremely unhappy in both.) Having some experience with [high pressure profession], I would say that they are equally as happy as the nerds and jocks I went to school with.

    • Pku says:

      I think it’s a bias caused by the fact that unhappy nerds are very conspicuously unhappy – Most people who are miserable in high school just tend to be quiet and fade into the background, nerds are probably used to being good in class, so when they’re unhappy they try compensating by getting more involved in school instead of less. (I can think of a few other mechanisms for this.)
      This is backed up by what I saw in my high school (though if american schools live up to their reputation they’re probably much worse) – some nerdy people were miserable and some were happy, but most of the miserable people weren’t nerds, they were just quiet types you almost never noticed.

  21. Wrong Species says:

    I don’t think basic income is going to work for someone who is non-verbal and violent.

  22. Maybe someone has mentioned this, but how weird is it that first Asperger’s is redefined as autism, and now all the Asperger folk are whining that autism isn’t a disease?

    And why are so many people tolerant of such narcissistic jackfoolery? Scott should just tell Dylan to drink a big cup of shut up and be happy he’s just an obsessive nerd.

    • Justin says:

      Methinks you need to look into the reason Asperger’s was ever not defined as autism. Kanner straight-up stole Asperger’s work for himself and projected his own mommy issues onto it and it’s taken decades to get back to where things started.

    • TrivialGravitas says:

      I am strongly skeptical that any of the people claiming this are actually both autistic and out of school (whether high school or graduate school), Asperger’s or otherwise.

    • Airgap says:

      Scott by nature prefers to tell people to drink a big cup of shut the fuck up in a way which is easily mistaken for polite & honest disagreement. Frankly, I admire the subtlety.

      • Well, it makes his posts about four times as long as needed–and I speak as someone who rarely uses one word when a thousand will do.

        Besides, subtlety is one thing. Seriously engaging with narcissistic wankery quite another.

    • LPSP says:

      I agree with everything but your tone.

    • RCF says:

      What is weird about that? It seems to me that one of the primary functions of the term “Aspergers” was to have a term to refer to the “good at math and makes cute hand flap motions” version of autism. As this distinction is devalued, it is not surprising that Aspergers would be more resistant to the idea that autism is a disease.

  23. Shirube says:

    I find it understandable that conversation about a cure for autism all comes down to tribe politics. What else would it be? As far as I understand, and as far as I’ve ever been able to find out, autism is a just a wide selection of correlated traits. I’m not even sure how tightly or loosely they’re correlated.

    A cure for being nonverbal I would support without needing so much as a moment’s thought. I would support some forms more than others, but communication is important, and I don’t think you can justify leaving someone without the means to express their preferences on the grounds that they might prefer that you do so. A cure for sensory issues… I’m not really sure what this would mean. Would it change how you perceived different tastes and textures? Would it change whether they were pleasant or unpleasant for you? Would it allow you to function more effectively while exposed to sensations you find aversive? I don’t really have an issue with any of those, but again, I’d like to know what a cure would entail.

    A cure for systemic thinking? I can’t really see that having any net benefit.

    Honestly, I find it ridiculous that the idea of a cure for autism has generated so much controversy. It’s true that autism isn’t a disease. Diseases have clear effects, and often clear causes. Autism is just a useful label for a cluster in mindspace. I don’t think it’s even one that reliably has the same meaning for different people. Whether or not it would be good to have a cure for autism, let alone whether or not it would be good to get rid of it entirely, seems like an issue best confronted once anyone involved has some idea what at least half of the terms in the proposal mean. (Or all of them. Just, you know. Baby steps.)

    • Justin says:

      As clarified elsewhere in the comments here, non-verbal is one of those terms that needs repeated clarification. People who are non-verbal are not necessarily non-communicative.

      • Shirube says:

        When I said that I would support some cures for being non-verbal more than others, I meant that I would prefer a “cure” in the form of other modes of communication becoming available and accepted. There would have been more than no hint of that fact in the paragraph I had originally planned out, but I got a bit sidetracked. I apologize.

  24. Alicorn says:

    I mostly agree with you about most of the positions you put forward here (although my spin on X-Treme Pro Choice differs). I want to add my voice to ilzolende’s point about how desperately inadequate our youth rights situation is to dealing with communication-capable neurodivergents who have conditions they want to keep, notwithstanding my wrenching sympathy for people whose children have conditions that the parents are not capable of happily shouldering. And I want to mention two other things.

    First, you draw a lot of attention to the fact that autism is comorbid with a lot of things. Since these things can occur independently and autism can occur without any given one of them, is there any reason to believe that a “cure for autism” – in whatever form it might appear – would be an effective way to deal with the harms of these comorbidities? If autistics are depressed and it’s very sad that they’re depressed, curing autism rather than taking it as another reason to (I think uncontroversially?) cure depression seems like an odd move. The extent to which it would be good to cure autism is significantly tied to the extent to which autism alone is working mischief, if a post-cure person would still have seizures or what have you.

    Second, while for more or less the reasons you put forward I would *love* to make a prenatal cure or prevention available, I think that you’ve bewilderingly understated (insofar as you have stated) the assault an involuntary postnatal cure (as implied in last non-footnote line) would represent. I cannot contort my mind enough to identify as part of my personal continuity some post-the-cure-is-released-into-the-air-or-something person inhabiting my body wearing a wool turtleneck and popping Wint-O-Green lifesavers into my mouth. Like, okay, that’s sure somebody, maybe my husband would still love her so he’d be fine and maybe on balance I’d even volunteer to make the sacrifice to help this category of people in such dire straits, maybe, maybe, but I want a fucking *statue* for it and I do not see plans for a statue in this post.

    • I don’t think anyone supports, or anticipates as a likely outcome, the involuntary curing of existing autistic people who aren’t a) institutionalized, b) legal minors, or c) dependent on government benefits for survival as a result of their disability. So you’ll be fine.

      (Well, okay, some people probably support this but their moral frameworks are defective, and some people probably anticipate this but their conspiracy-theory detectors are defective.)

      • Alicorn says:

        Yes, I’m talking about the thought-experiment all-or-nothing version. (Or, alternately, an invented-when-I’m-twelve version or an invented-if-I-were-just-slightly-less-functional-and-maybe-a-dude-to-make-housewifery-impractical version.)

    • Tracy W says:

      On the last point, isn’t this a common oddity of life? Most of us have family histories with some misery in them – for example if there had been an easy cure for schizophrenia in the 1960s my brothers and I would probably never have been born. So I’m in the mental state of being glad we exist and also thinking said cure would have been a very good thing.

      • Alicorn says:

        I think it’s very different to talk about who would be born than to talk about who would, as an already-person, be altered. I don’t think you understood me.

      • David Kinard says:

        But any type of change to society will change who is born and who isn’t…. there is no “plan” of the right way for history to go. What about the people who weren’t born because if they had a cure, some other chain of events would have happened leading to different people being born?

    • ilzolende says:

      Thanks for bringing up the continuity issue, I was taking it as a given for “why nobody wants certain types of cures” and not remembering to mention it. Depending on what a cure looked like, it might not be equivalent to death-plus-a-new-person-existing, but I’m not sure you can really call it a cure.

      You won’t need to restrain me to brush up my executive function or distribute a version of Google Glass with face and emotion recognition or even to increase my tolerance to undesired sensory stimuli a bit. (Liking those stimuli, on the other hand…)

      An Ilzo focused on socializing to the extent of tailoring her (if we’re coercively curing autism, why not cure transness while we’re at it) patterns of interacting with people to optimize for being likable to everyone, whose favorite hobby was going clubbing, who couldn’t read more than a couple hundred words per minute, who could memorize an address book of names and faces but not a single sonnet, who could dance but couldn’t sing, who loved exploring deep ambiguous symbolism of litfic and couldn’t stand STEM fields beyond what was strictly necessary for her would be a perfectly nice person (if not the sort of person I would want to be friends with). That person would not be me. I, in fact, like myself better than a perfectly neurotypical me.

      Being coercively required to donate organs I needed for survival would be similar, except that in that case there would be more lives saved and the users of my body would already have existed in advance. Also, it would be theoretically possible to compensate me with cryo or something. Whereas in the case where someone else with my memories ends up running around with my body, I probably don’t get to so much as write a will before Fully NT Ilzo spends GiveWell’s and ASAN’s (and maybe some more radical group’s, in such a scenario they’d be bound to pop up) money on a used car. (Fully NT Ilzo is probably not the sort of person who would understand what a precommitment is, much less be willing to follow through with mine.)

      (I’m not personally threatened by a coerced cure, as unless synthetic oxytocin is more than just “increases trust, might temporarily decrease nonsocial cognition, got to skip animal trials because prior use for induced labor, keep it the – away from me” there’s not anything that would be developed before I turn 18. And it sounds like Turing Pharma’s business model is “make stuff really pricey”, so that’s another obstacle to oxytocin. And I could probably get myself to a wide variety of locations in the US on short notice if that were really necessary, which it won’t be.)

      • Rebecca Friedman says:

        Why does an NT version of you have to enjoy clubbing, be unable to sing, and be unable to memorize sonnets? Honest confusion here – I really really really don’t want to offend you, I just don’t understand. I’m NT (as is probably obvious from the question), but I can memorize sonnets (and enjoy doing so) and sing (not super well, but that’s not a function of my NT-ness; most of the people I know who sing better than me are also NT), and have no interest in clubbing (though I do enjoy dancing). Am I misunderstanding…? Sorry!

        • ilzolende says:

          I am not at all offended, and I don’t think you’re misunderstanding me. (Well, obviously you didn’t get all of my intended meanings from the other post, or you wouldn’t be asking me questions, but you haven’t drawn bad conclusions.)

          A not-meeting-diagnostic-criteria version of me could essentially still be me. They would be pretty darn autistic, though, just not quiiiite enough to meet diagnostic criteria. (Many of my family members have the more desirable parts of autism.)

          A fully neurotypical version of me, that wasn’t “Ilzo, now with added executive function and emotion-reading skills!” would be pretty drastically different from me. Probably not in all of those ways, but my memorization skills are autism-linked, my hyperlexia is autism-linked, and lots of other traits I like about myself are autism-linked.

          It is possible to have lots of these traits and not have autism! But since I’m autistic and the traits are autism-linked, it seems to me like a cure would reduce the extent to which I exhibited them. If people’s idea of a cure would get rid of comorbid seizures or gastrointestinal issues or whatnot, despite those being possible to acquire without autism, a cure by that standard would not merely drop my autism levels just below diagnostic standards, it would affect other autism-linked traits as well.

          • Rebecca Friedman says:

            … Huh, OK. That makes sense. Thank you very much!

          • Meredith L. Patterson says:

            FWIW, my solution to wanting “Meredith, but with more executive-function and emotion-reading skills!” has been to train those skills. It’s slower going for me than it is for neurotypicals, but there’s a lot of material out there in the Getting Things Done vein that can still work. Usually I have to hack it a little to get around autism-linked obstacles; this is hard to generalise since those are always so personal, but happy to discuss the concept further if you’re interested.

            For emotion-reading my approach has been more of “treat hyperlexia as a superpower and act accordingly.” There is an art to asking people questions that encourage them to share their feelings, and if my goal is to get that information, I don’t really care whether I obtain it nonverbally or verbally.

          • Anonymous says:

            there’s a lot of material out there in the Getting Things Done vein that can still work. Usually I have to hack it a little to get around autism-linked obstacles…

            Please, elaborate.

        • HlynkaCG says:

          Because it seems NT in this context is the disease.

          The real question you should be asking is why are we trying to “cure” autism rather than make everyone else more autistic?

          • David Kinard says:

            This gets back to the “high functioning” versus “severely disabled” thing. I’m all for trans-humanism. Why not go for the best of both worlds?

      • Deiseach says:

        Why do you think a non-autistic version of you wouldn’t be interested in STEM fields? Or unable to sing? I’m the odd one out in my family for not being able to sing/play an instrument and being hopeless at maths, and as I’m banging on, I think we probably fall into the Asperger’s end of the spectrum.

        For my part, reverse the “deep ambiguous symbolism of litfic and couldn’t stand STEM fields beyond what was strictly necessary for her” to “love maths, hate literature” and okay, I’ll run screaming into the night 🙂

    • Scott Alexander says:

      Regarding comorbidities: I agree that if you cured every single problem associated with autism, but left some sort of core of non-problematic autisticness behind, that would be the sort of win-win situation I end by talking about, and that this is a desirable outcome. But when I think of “autism cures”, I think of germline genetic engineering – I really doubt anything else will work – which would solve everything with one fell swoop. That is, I am more optimistic about someone inventing germline genetic engineering (or something similar) for autism, than I am about people inventing good cures for seizures and cerebral palsy and tuberous sclerosis and intellectual disability, etc, etc, etc.

      You’re right that I don’t think much about postnatal cures for two reasons. First, I don’t think they’ll work; autism is really hard-wired into the brain and nothing can reverse that much brain-wiring once it’s happened. Second, if it did, I would expect it to be some pill that you have to take every day. A lot of the moral problems become less pressing if you can try it, go off it if you don’t like it, maybe take an extra dose the day you need to go to a big meeting and then maybe cut back on weekends, et cetera.

      Regarding you not being you – a lot of my experiences about this are shaped by me going on antidepressants to treat my OCD. I had a lot of the same worries – will Scott-without-OCD still really be Scott? Am I sort of killing myself and replacing myself with somebody else? And…well…I can’t say for sure that it didn’t, but it kind of feels laughable in retrospect. That’s made it harder for me to take that argument seriously, although I guess that could just be Evil-Fake-Scott following his self-interest in replacing other people with evil fake versions of themselves.

      (I realize that me not having OCD is a less dramatic change than a severely autistic person becoming totally neurotypical. But I’m not sure it’s a less dramatic change than you loving mints, so maybe our disagreement still holds)

      Do you have the same replacement-intuition about a nonverbal nonsocial autistic person who receives therapy, does really well in it, and ends up as somebody like you? If not, why not?

      (Oh, and I am happy to build you a statue, but it is not very good and will probably be a misshapen lump of clay and you will complain that I made your hair redder than it is.)

      • Alicorn says:

        Doesn’t whether genetic engineering solves the comorbidities depend on why the comorbidities exist? There are identical twins where only one has autism, aren’t there?

        I was “more autistic” when I was a little kid (partly because I hadn’t learned very much yet and partly for control-of-environment reasons like you describe in OP that apply to children as well as the institutionalized) and that wasn’t the direction it went – I was loud and carelessly affectionate and usually had a couple friends even if I wasn’t actually popular – so when I imagine a version of myself who is “more autistic” I don’t imagine a withdrawn person who can’t talk. (…Maybe if my parents were worse than they in fact are?)

        I sometimes go nonverbal, but this is a thing that happens only when I’m really tired, I can always still write and receptive language is always intact, and I can dredge up spoken words if someone impresses on me that I really really ought to, so I don’t think I have a *good* understanding of what perpetual nonverbalness is like from the inside.

        The question’s also a little hard to formulate in the reverse direction because someone who was nonverbal and nonsocial could not share my personal history, while someone who was abruptly cured as an adult could.

        Do you mean “what if the cure only got somebody as non-autistic as Alicorn and not Full NT, would a recipient still be themselves?” Well… take away my control of my environment and I don’t actually work very well. To get someone as non-autistic as me, optimistically you could do nothing more than give them a small emergency spoon reserve for communicating needs so they could if adequately supported and unhindered build themselves a nest (and maybe remove any sensory sensitivities that make being in a body intrinsically unpleasant, if that’s what’s going on). But I’m really lucky that I have so much freedom to build my nest. Like, I get to spend somebody else’s money and eat only ever *exactly* what I want and exercise near-absolute power about who lives in my house. A lot of even quite functional people don’t have and can’t get that. So even a cure that left hand-chewers only as autistic as me would also have to come with institutional solutions or an appropriate number of marriageable software engineers.

        • Justin says:

          There’s a 70% overlap in autism diagnoses among identical twins, and given that the diagnosis is still a subjective one, I’m willing to say the actual rate of the condition itself is much, much closer to 100% and that this overlap only really covers certain perceived behaviours that can be supressed through socialization.

    • Anonymous says:

      I’m not sure what changes if you break down autism into “all the characteristics that are collectively termed ‘autism'”.

      I also think this “oh no, what if I change as a person and I’m not me anymore?!” thing is nonsense, for reasons I’ve given elsewhere in the thread. My reason for thinking this is that it seems to be true of absolutely any change that a person might undergo, whether voluntarily as an adult or involuntarily as a child. Learning to read, for example, destroys the illiterate person that existed before and puts a literate one in their place. Is that an argument against teaching children to read? Does it hinge, as I suspect, on how long it takes – so you wouldn’t want to press a button to transform an illiterate child into a literate version of that same child, but you would be okay with a gradual process of teaching them to read?

      If so, what is the speed limit for change that you are comfortable with, and why?

      • Alicorn says:

        Well, volunteering for things makes a big difference. There are lots of large changes I’d gleefully accept as instantaneous upgrades, including many that would be reasonably summed as “learning”. There are others I would experience as ego-dystonic, incompatible with my goals, unpleasant, in contradiction with my values, impractical for my life situation, or something else, and would not want at any speed. If someone imposes changes on me against my will, this is a problem whether they’re doing it indirectly by exposing me to experiences I resent or directly by releasing an autism cure into the air.

        If you can make kids literate by snapping your fingers, you can also afford to wait until they can agree to this procedure.

        • Anonymous says:

          “If you can make kids literate by snapping your fingers, you can also afford to wait until they can agree to this procedure.”

          Sure. Although, it surely also depends on whether you can make them illiterate by snapping your fingers too. Assuming you can, we are faced with a problem: you have to make a choice for them. Are they going to spend their childhood (up until whatever age we deem them able to choose for themselves) literate, or illiterate? My point is that I don’t think ‘whatever they are born with’ has any magical intrinsic value, certainly not if you more generally believe action and inaction to be morally interchangeable.

          Okay, now imagine literacy works like it does now. Is that an argument not to teach your child to read? After all, once you do, they cannot very easily un-learn to read. (At least, I don’t think so? I don’t expect this is something anyone has ever tried?). On the other hand, once they are old enough to make up their own mind, they have already experienced some number of years illiterate, which they can never get back. Was it worth it? What value is a person likely to get from being illiterate, anyway?

          I think ultimately parents always must make some choices for their kids – and choosing to go with whatever they are born with, or whatever they develop into with no intervention, is itself just one choice among many.

          • Alicorn says:

            I… I don’t believe action and inaction to be morally interchangeable. Does this suffice to explain how thoroughly you’re talking past me?

          • Anonymous says:

            Okay. Since many people here seem to I thought it might apply to you too, but never mind if not.

            Since a child must undergo several years of dependence on their parents before being able to look after themselves, their parents, or whoever else is looking after them, must necessarily make choices for them. Do you agree with that?

            If so, would you also say that, assuming all else is equal, it is better for parents to do whatever choice best resembles ‘not intervening’? And if so, how much value do you place on that aspect? Presumably you would rather a parent intervene to stop a child from touching a hot stove, to take an extreme example?

          • Alicorn says:

            Parents have to make choices for children but have many degrees of freedom in how much attention they pay to their child’s (uninformed, poorly-communicated, but likely still present) desires, and how they form their predictions about the results of what they do.

            Intervene to avoid burns? Vaccinate? Yes.

            Oblige kid to eat food? Yes, because if people don’t eat they starve and this is really bad – but conduct a concerted search for a way to meet nutritional needs in a less aversive way.

            Teach kid to read? Well, if the kid won’t sit still for it – no, do not imprison and torment a kid who doesn’t seem to be up for learning to read. Maybe screen for dyslexia. I can’t think of a thing I’d describe as “making a choice for” a potentially-literate child that contradicts expressed preferences of the child and isn’t at least mildly horrifying. You can’t puppet their bodies to make their eyes track the words on the page, you can’t perform cartoon hypnosis on them to make them care about phonics. You can offer them books and you can bribe and threaten and reason, and some of those tactics need more justification than others.

        • David Kinard says:

          “Exposing me to experiences I resent.”

          I realize you are probably talking about immersion type therapies here, but generally, it is not and should not be an obligation for people to not expose other people to experiences they resent. There are certain types of experiences where that applies, like getting punched in the face. But I think a big problem is when that line is drawn further towards the spectrum of the easily offended.

    • Marc Whipple says:

      While I was discussing this with my wife last night I asserted that if somebody put a button in front of me and said, “Push this button and your daughter will instantly become neurotypical,” you wouldn’t even see me move. (I am not as young as once I was, but I am surprisingly quick.)

      Then I said, “If they said, ‘In effect this button will kill your daughter and replace her with an exact duplicate who isn’t autistic,’ I’d still push it. No delay would be noticeable.” This is my ultimate answer to people who complain about non-voluntary cures. You do what you want about your kid. This is my kid.

      The conversation didn’t go anywhere useful after that. But it’s a data point for you. My daugher is a good kid and I love her. But I am so worried about the kind of life her autism will condemn her to, especially when her mother and I are gone, that I’d push that button even in Case B. Do I have the right to do that? Let me be perfectly frank: I don’t care. I have a responsibility. To protect her from that which she cannot protect herself from. In my opinion, pushing the button falls within that responsibility.

      (In my defense, if this is a defense, if the button-giver said, “Push this button and your daughter will become neurotypical and you will fall over dead,” I still would not hesitate, though maybe I’d take a little time to get my affairs in better order if that wouldn’t invalidate the offer.)

      • DrBeat says:

        You wouldn’t hesitate to push a button that kills your daughter.

        You would do this because you have a responsibility to protect her. Because you have this responsibility to protect her, that makes it okay to kill her.

        I’m not sure that I agree with you a hundred percent on your police work there, Lou.

        • Marc Whipple says:

          I meant this as a response to the “curing someone kills the person who they are” line of argument. You will note the words “in effect.” It was me saying to people making that argument, “Can’t prove you wrong, don’t care.”

          If it literally killed her and she was lying there with an exact replica standing over her corpse being neurotypical, that would be different. For one thing, getting rid of bodies is a lot harder than it seems like it should be. For another, it’s different.

      • Alicorn says:

        I actually wouldn’t have a problem with you button-pushing as long as your child is under threeish, or sufficiently autistic that you couldn’t possibly ask her even if you were making a truly heroic communication effort.

        If we’re talking about, like, an eight-year-old who can talk (even if it’s only on special occasions), let alone an adult daughter, we have a disagreement, and I start wishing it was easy for you to give her away to somebody who’d care to look after her as she is now. (I mean, it doesn’t sound like you think your personal absence would harm her too much…)

        My answer to “you do what you want about your kid. This is my kid” is that this argument stops applying when your kid can be her own.

        • Marc Whipple says:

          I am trying very, very hard and almost entirely succeeding, save for this one-level-up reference, not to come back with a “How dare you” response to that.

          Now that I’ve got that out of my system…

          My daugher is not capable of understanding the question, “Would you like to be neurotypical/not be autistic any more,” let alone the implications of the answer ‘yes.’ (Ironically, if you asked her that, she’d say yes, because she answers any question which she does not understand with ‘yes.’) This is despite the fact that she is reasonably verbal and, in fact, it would probably take most people at least a moment to figure out there was anything wrong with her at all if she initiated communciation regarding something she wanted.*

          So in regard to this question, my kid can not be her own, nor will she ever be able to be her own. In fact, society is ready, willing and able to hold me responsible for her. And that’s fine. Last week I even filed guardianship papers so I can more ably and efficiently represent her interests. But if I am responsible for her, I am responsible for her, and I feel quite ethically justified in saying, “Hell yes I’d push that button.” Because it is a chance for her to live a safer, more independent, more fulfilling life. (You can tell me her life is sufficiently fulfilling, and I cannot, in all honesty, gainsay you. I will still laugh at you for saying it.)

          *E.g., she is quite capable of going up to the proprietor of the comic shop, saying, “I would like some Pop-Tarts please,” handing him a dollar to pay for them, and saying “Thank you” at the conclusion of the transaction. He knows she’s autistic: were she to do this in a place where the cashier didn’t know she was autistic, so long as she didn’t have to make change I doubt they’d think anything of it.

        • keranih says:

          I start wishing it was easy for you to give her away to somebody who’d care to look after her as she is now. (I mean, it doesn’t sound like you think your personal absence would harm her too much…)

          This strikes me overwhelmingly as deeply uncharitable.

          I will also remind you that even for DS children adoption in the USA is not anything like “easy.” (It’s one of the downsides to the longstanding high abortion rate – children needing new homes are in very short demand.)

          • Marc Whipple says:

            Actually I wish it was easy too. Then maybe I could find somebody who was younger, in better health, and more financially secure and for the first time in fifteen goddamn years not spend every other minute of every waking hour worrying about what’s going to happen to her when her mother and I can no longer care for her.

            Yep. That’d be swell. I wish it was easy.

            In fact, I think I’ll go think about how easy I wish that was, and bow out of this conversation. I apologize for entering it: I should have known it would not be helpful. If I have offended anyone, I apologize. I overestimated my ability to maintain detachment.

          • Alicorn says:

            That was exactly my point: it is not easy to match kids needing care with people who want to care for them. That is what the word “wishing” is doing in that sentence.

          • Creutzer says:

            It’s one of the downsides to the longstanding high abortion rate – children needing new homes are in very short demand.

            Wait, you’ve lost me here. Wouldn’t one think that a high abortion rate leads to low supply in children needing new homes? What does it have to do with the demand side?

          • keranih says:

            If Marc’s out, I’m done, too.

            @ Creutzer –

            Thank you for catching that mistake. Yes, children available for adoption are in very low supply, high demand, and the red tape to open a home as a foster or guardian is enormous, making transferring guardianship to someone else (rather than to the State) extremely difficult.

          • @Marc Whipple: FWIW, I appreciated you sharing your viewpoint.

  25. mersenneprime says:

    “somebody develops technology that can change your brain type during adulthood”
    So my first reaction was “this sounds cool and I want to try it”, and my second reaction was “wait but flipped!me *isn’t me* so they might have a different opinion that makes it impossible to decide objectively what is better”
    …which ends up sounding awfully like the arguments surrounding wireheading…

  26. Mark says:

    Here’s another thought experiment. Supposing we had no cure or treatment for malaria, would you support trying to eradicate the sickle-cell gene?

    • Scott Alexander says:

      I’m confused. If we had no malaria treatment, it would be very important to keep the sickle cell gene around. Are you saying that autism is the extreme version of traits that are very useful?

      If so, I kind of agree! But then the question becomes “How do we keep the useful traits without getting the more serious condition?” I expect this will not be too hard. Just to give a vastly oversimplified model, suppose if you have fewer than ten copy repeats of some gene you’re irrational, if you have between ten and twenty you’re a good logical thinker, and if you have more than twenty you’re autistic and nonverbal. Then we can talk about maybe trying to keep people in the ten to twenty range.

      Real autism is no doubt a zillion times more complex, but I think the same principle might apply.

  27. David N says:

    “On the other hand, if a mother wanted an autistic child, and she was somehow sure that she could support that child and help him or her flourish, I would be okay with her aborting however many neurotypical fetuses it took.”

    This is where I had to duck out… You did an excellent job driving home the point about how severely autistic people can exhaust even the best trained professionals and suffer despite everyone’s efforts, but then just because some lady is “sure” you’d be cool with that plan.

    • ilzolende says:

      I’m autistic, and if you guys all collectively stop having autistic kids I’ve got to ensure the future existence of people with some resemblance to me somehow.

      I am pretty sure I prefer a world where people like me continue to exist well into the future (I am a person like myself, if you want a very straightforward and morally simple if not easy way to deal with this preference, btw) to the alternative, even if I have to deal with unpleasant stuff to get there. I wouldn’t be excited to need to raise children, but I’m also not excited to have a future happen without anyone like me in it.

      And I’m pretty sure we need to start separating classic autism and Asperger’s in the rationalitysphere again, because I was not an atypically difficult kid.

      • David N says:

        I can’t be on board with that. I’m not sure I can defend it on rational grounds. Aborting a girl because you want a boy, arborting 12 sighted fetuses because you want a blind one, or aborting N “neurotypical” (in quotes because I don’t know *exactly* who that excludes) fetuses because you want one (mildly) autistic one, are, to me, increasing degrees of wrong. I’ll hand in my 100% pro-choice badge at the office.

        While we’re dealing in hypotheticals, we could have the exercise where the desire to “ensure the existence of someone like me” by a long sequence of abortions is reduced to a “likeness” that is absurdly vain and trivial and show there’s a stop where everyone gets off this train. But why bother. You can probably think of a more persuasive example than I can.

        • ilzolende says:

          Oh! The issue here is abortion! I thought the issue was “why are we trusting people to truly want to have autistic kids when we’ve just talked about autistic kids being challenging”.

          I don’t think I’d have to abort a lot of fetuses to get one close enough to autistic. Autism is genetic, IIRC? Surely I have the correct genes for ending up with a high rate of autism, especially with an autistic partner? I’m not insistent about meeting all diagnostic criteria.

          While we’re dealing in hypotheticals, we could have the exercise where the desire to “ensure the existence of someone like me” by a long sequence of abortions is reduced to a “likeness” that is absurdly vain and trivial and show there’s a stop where everyone gets off this train. But why bother. You can probably think of a more persuasive example than I can.

          That’s probably just “resorting to human cloning”, a generally not-approved-of plan.

          And I don’t think it’s vain to want my neurotype to not be eradicated. I’m not planning to have kids of my own except in weird scenarios like this. I expect the general population to contain nonzero quantities of traits that I’m personally attached to, because it’s done that for a while. If someone starts messing with that, I’m going to have to do my part to address it.

          Also, abortion shouldn’t be needed in order to get rare traits: IVF and pre-implantation selection are things you can do. Ignoring any humanitarian concerns, carrying 12 fetuses to the point of being able to do all the desired genetic tests (which is when? IDK) is probably pretty time-consuming and resource-consuming. Most people won’t want to do that (this baseless assertion is pulled from the luminiferous aether, it might be wrong).

      • chaosmage says:

        We have mass market consumer VR coming up in a few months. Nobody knows what new social networks and technologies will arise from that. But VR will certainly make it much easier to control one’s own sensory input.

        VR should make life much easier for autistics. I would not be surprised if they even turned out to be better adapted for it than neurotypical people.

        So I don’t think you need to worry about the future of autism. It should be safer than the present.

      • moridinamael says:

        I don’t think “autism” is regarded as being, like, a scalar quantity. Intelligence is highly polygenetic. Brain structure is highly polygenetic. Autism is at least somewhat polygenetic, in some sense, with complex interaction with environment, possibly.

        Most really smart people I know are unusual, weird, nerdy, whatever. This is completely predictable. Any genetic deviation from an average neurotypical 100-IQ brain is going to by definition cause cognitive and behavioral changes from the baseline. The miracle of somebody like Einstein isn’t that he was capable of highly abstract thought, it’s that he was capable of highly abstract thought while still being completely functional at other human activities. In other words, the genes that provided his “genius” didn’t break the rest of his brain.

        Treating autism as a “scale” ignores this reality. Treating it as a binary is even worse. Nobody here is advocating curing smartness, they’re advocating curing a complex cluster of poorly understood malfunctions that on net lead to greater suffering.

        As a completely separate line or argument: I have heritable disorders. I would excise those genes from myself in a heartbeat. I feel no urge to “ensure that people like me continue to exist well into the future” vis-a-vis these disorders. I’m sure I could make some argument about how these disorders caused me to struggle and the struggle made me more resilient or something, but that would just be justification/sour grapes.

        • “Most really smart people I know are unusual, weird, nerdy, whatever. ”

          Most really smart people are unusual because it’s unusual to be really smart. But your comment about Einstein being unusual in not breaking his brain suggests that you are thinking of something different, and more problematic, than that.

          In which case I disagree. I’ve known quite a lot of really smart people, including at least five Nobelists in my field and (less well) a couple in others. None of them struck me as having in any meaningful sense broken brains, or even as being any odder (aside from high intelligence and different interests that went along with it) than other people.

          I spent a number of summers long ago as a councilor at a camp for gifted children. Off hand, I can only remember one of the really smart ones who struck me as a bit odd along the lines you seem to be suggesting.

          • Marc Whipple says:


            The ones you notice are noticeable. The ones you don’t, are not.

          • Chalid says:

            Also, successful and secure people of any type don’t have to care as much about social conformity, so they allow themselves to do more unusual things.

          • onyomi says:

            Are there any studies on whether people with high IQs are more likely to suffer with psychological problems (possibly confounded by the fact that smart people might be more likely to seek diagnosis and/or help)?

            My subjective impression has always been that there was a correlation (an arguably comforting notion to me, considering I’ve had some psychological problems), which seems to make sense in that, the same way a 7-foot tall person is more likely to have certain problems, or a dog bred to have an unusually flat face is likely to have certain problems a mutt might not have, someone with one part of them way more developed relative to other parts seems more likely to have problems with that part, even if it is also better at certain things.

            Related, I often feel that the same qualities which make me “smarter” than average also make me more prone to certain problems like, bipolar, anxiety, and OCD: my tendency to be obsessive is a useful trait for learning things, for example, as is my tendency to get strong bursts of energy and creativity, sometimes compensated for by periods of feeling down (I’ve been diagnosed as having a type ii bipolar, though not a very severe case, I guess–depending on who you ask I might be mildly bipolar or just with a tendency to higher highs and lower lows than most, often cycling within the same day).

            But contra the above, most of the famous “tortured” artists like Van Gogh *don’t* actually produce their best work during their darkest periods psychologically, meaning it’s certainly not necessary to suffer mentally in order to be productive/creative. At the same time, it seems clear to me that whatever caused Robin Williams (and Van Gogh, indeed) to commit suicide was probably the other side of the same coin which gave him the manic energy he was famous for.

            But, of course, people of average and below-average IQ also get anxiety, depression, ocd, panic, etc. and we maybe don’t remark on that as much, either because they don’t get diagnosed, or because their suffering from such isn’t a convenient explanation for some kind of weird genius. And of course there are plenty of very mentally healthy yet very smart people, though I think smart people are also, by virtue of their smartness, better able to handle their own mental problems. I, for one, don’t need any psychiatric meds and am pretty psychologically healthy most of the time (at least for the past few several years), but only because I’ve figured out a lot of strategies for keeping myself sane.

          • US says:


            “Are there any studies on whether people with high IQs are more likely to suffer with psychological problems”

            Some research has looked at that kind of stuff – a few observations:

            “co-morbid diagnoses of other mental disorders are common among this population. Individuals with Asperger’s are 5.7 times more likely to develop symptoms of depression in comparison to the typically developing population (McHale, Dariotis, & Kauh, 2003; Stewart et al., 2006). The literature suggests that most individuals with ASDs show a desire for relationships, but experience loneliness because their difficulties with social skills often interfere with friendship formation […] higher-functioning adults with greater intelligence and less autistic symptomatology tend to experience more depression, anxiety, social isolation, withdrawal, and peer victimization […] than lower-functioning individuals. This may be due in part to greater social expectations often placed on higher-functioning adults occurring as a result of placement in less protective and more inclusive settings. With higher-functioning adults with ASD often giving the appearance of seeming more “odd” than disabled by their peers, these individuals may be more susceptible to peer rejection, and consequently greater negative socio-emotional outcomes like depression and anxiety. Furthermore, greater self-awareness about peer rejection and “differentness” more likely found in higher-functioning adults with ASD may also contribute to greater depression and anxiety”.

            The quotes are from the book Adolescents and Adults with Autism Spectrum Disorders. As should be obvious there’s some speculation here about mechanisms; not many studies have been done on these topics.

            On a related note:

            “Understanding which variables predict adult outcomes in ASD is a crucial goal for the field, but we know little about what variables predict different outcomes. […] Longitudinal studies of ASD from childhood to adulthood have consistently yielded only two useful prognostic factors for adult outcome in ASD. A childhood IQ score in the near-average or average ranges (i.e., ≥70) and communicative phrase speech before 6 appear necessary but insufficient for a person to access a moderate level of independence in adulthood […] Individuals having these childhood characteristics have widely varying adult outcomes, so exhibiting these characteristics in childhood is no guarantee that a person will achieve adult independence. The predictive utility of other childhood variables has been examined. Findings regarding severity ratings of childhood ASD symptoms have been mixed” (from the same book).

            [Hmm…. Rereading your comment I realize you probably did not mean ‘…in autistics’, but rather ‘in general.’ I’m unfortunately not familiar with that literature..]

      • BBA says:

        I’m barely on the spectrum, and I wouldn’t want there to be more people like me. This world wasn’t made for people like me, and adding more would just create a lot more suffering without good reason.

    • Scott Alexander says:

      This is more of a hypothetical discussion of the moral principle than a discussion of whether such an assurance would be believable.

  28. keranih says:

    I think this is a very useful article for opening up discussions of the tensions between the individual and the society – between my need for liberty and self determination, and of society’s to impose uniform rules and to urge predictable useful behavior from each person. For that, many thanks.

    (I think Scott is entirely offbase, if not completely inaccurate and wrong, concerning the relative worth of cattle and people, and concerning the social utility of on-demand abortion, but wow are those major derailers. I am going to try very hard to not engage on those.)

    There is a tension between ‘do as you see best’ and ‘accept the ethical guidelines of the group so that the group can function better.’ I think both are poisonous when taken towards the extremes – and you don’t have actually *get* to the extremes to run into trouble. I think a lot of our internal politics rests on this tension.

    I think Scott highlights this when he mentions GBI in the context of a disease spectrum that includes independent people, people with minders, and institutionalized people. Are these not citizens? When we cut them, do they not bleed? At the first of the month, should they not receive their payment? Is the State required to grant them the BI AND to provide expensive in patient care? Where does the check for the institutionalized get deposited, and who gets to use that money in the mean while? And so forth, which might be dismissed as getting too far down in the weeds, but we are in a regular debate over what rights felons and the mentally ill have.

    It was also very enlightening to realize that yes, inventing a gene treatment for whitening the skin of Africans so that they didn’t look like Negroes was going to be far more likely than society purging itself of appearance-based racism. ..wait. That wasn’t what you meant, was it….

    For me, I think the conflict might also be framed in terms of eyeglasses – I might not want to wear ugly horn rims. No one else is required to buy me fancy wire rims. I am not required to undergo optional surgical correction. Yet unless I do at least one of those things, I may not operate a motor vehicle on the road with other real live humans (and the occasional cow) on it. Throw in flying self driving cars, and we are right back at the ‘easy’ biological cure.

    I think a community-specific consensus on what to treat and what to socially engineer is far more likely to be found than an iron clad principle of justice.

  29. Berna says:

    I have an autistic friend. She’s very high-functioning; I’d not even noticed anything special about her until she wrote about it on Facebook, she has a job she likes and lives with her boyfriend, and before that by herself. She says she’d flipping *love* a cure. And it’s not because of the way she gets treated, but because of the overstimulation, the difficulty of telling what emotions others (or even she herself sometimes) are experiencing and the PCOS that goes with it.

  30. Rachael says:

    I agree with you (apart from the abortion part, but that’s secondary).

    Autism campaigners seem to be using the fallacious argument:
    * Quirky shy nerds are autistic too
    * They don’t need curing
    * Therefore autism doesn’t need curing

    Collapsing autism and Asperger’s was probably a mistake. Keeping the distinction would make the above fallacy more difficult to commit.

    I don’t think the average person’s idea of an autistic person is someone nonverbal and violent, not any more. Maybe 30 years ago. But now it’s the quirky nerd. Because the former are hidden away in institutions, and the latter are visible and talking about how autistic they are.

    • Peter says:

      The taxonomic issue is pretty messy. Part of the issue with “Asperger’s” is that it was defined as distinct from HFA, with the key distinction being that in HFA you had a “language delay” and in AS you didn’t. There appear to be some other differences in traits… maybe – for example AS tends to be associated with higher Verbal IQ than Performance IQ, and vice versa for HFA. The studies don’t always replicate nicely, and at any rate it’s all “we took a big group and found a statistically significant difference” – intragroup variation is stronger than intergroup variation. Now if you look at the traits that correlate with the AS/HFA distinction, I seem to be pretty firmly on the AS side, but there seem to be a lot of people who are “somewhere in the middle”, and apparently it had been fairly common for some people to say AS/HFA and not to bother trying to tell the two apart.

      Finding the HFA/LFA distinction is tricky too. Activisty types don’t like it, because “High Functioning” all too easily collapses into “this person has no problems that require support or anything like that” and “Low Functioning” too easily collapses into “this person has no abilities”. You could draw a line at some arbitrary IQ threshold but that has all of the threshold problems.

      Thing is, a spectrum is pretty good for representing reality but is less good for reflecting how people like to think about things; people like nice clear categories that are internally homogeneous with regards to the traits of interest…

      (Except I think that opinions about cure are much less correlated with level of impairment than some people think, but I think that’s for another comment)

      • ozymandias says:

        Also the problem with drawing a line at an arbitrary IQ threshold is that people who have high IQs can still be eplieptic self-injuring violent people with gastrointestinal issues. For that matter, you could probably have a high-IQ nonverbal person, even though at that point testing IQ gets a little difficult.

        • Peter says:

          Oh yes, years back I remember reading about someone who was sufficiently impaired that she couldn’t be left alone in a room with a hot kettle, and had lots of other issues – but was perfectly capable of writing some very sharp legal letters. At the time I half-wondered whether there should be a category, XFA (“Cross-functioning autism”), for people like that, but these days I worry that that would be adding to the problem rather than helping with it.

          • ozymandias says:

            See, that is why autism rights advocates disapprove of functioning labels. Because to a first approximation “people who are perfectly capable of some things which are very difficult but incapable of things which seem easier” is all autistics.

          • David Kinard says:

            But isn’t there a significant distinction to be made in terms of degrees of impairment? You had mentioned that many of the now high functioning autistics were low functioning in childhood. It seems like there would be quite a bit of survivor bias there. I.e, assuming the majority of the severely impaired are potentially high functioning if given the right treatment, versus those who go from low to high are a subgroup who is over-represented since they are capable of articulating their views.

    • Scott Alexander says:

      I agree that argument is a common failure mode, but I don’t think the really serious autism campaigners are using it. A lot of them are formally nonverbal or otherwise very autistic. Temple Grandin is certainly not just a quirky nerd who likes trains.

      I think if that misunderstanding were the extent of our difference this would all be a lot less serious than it is.

      • David Kinard says:

        It’s worthwhile to note that Grandin is apparently also in favor of “curing” those severely disabled.

  31. Tracy W says:

    And I’m still in favor of basic income. If everyone gets a basic income, autistic people who want to spend it on getting the care and support they need to remain autistic could do so without costs to anybody else.

    I’m rather baffled by how you think this will work. I thought the point of a basic income was that people wouldn’t have to do boring jobs for low pay. Is there that large a supply of people who would rather assist someone autistic for a small addition to their annual income, and do so reliably?

    • Jon Gunnarsson says:

      Why do you assume it would be a small addition to someone’s annual income? Any remotely realistic basic income would be much lower than the salary of a full time nurse. And that nurse would receive the basic income plus the salary (and probably pay much higher taxes, but the bottom line would still be much more than just the basic income).

      I see a diffferent problem with Scott’s argument here: a basic income would be very unlikely to cover the costs of someone who needs institutional care, at least if we’re talking about the foreseeable future.

      • baconbacon says:

        The amount an otherwise unemployed autistic person could pay thanks to a UBI would be limited by the UBI. If UBI is low how can an autistic person afford a nurse? High functioning autistics could either earn enough to supplement or have requirements low enough to need only relatively low cost supplemental care, but the extreme end of autistic people have much higher and more expensive needs.

        • Jon Gunnarsson says:

          A nurse can serve more than one patient. Also, many autistic people would receive support from their family.

          But as I wrote above, people are unlikely to be able to afford institutional care on a basic income alone.

          • baconbacon says:

            One nurse can rarely handle more than 2-3 patients with long term care needs. Before you doubt this remember that a full time job is 2,000 hours a year, which leaves 6,760 hours a year that their patients are unsupervised (by the nurse). Even if one nurse could handle 10 of them at a time (a wild stretch) you still need someone on weekends/holidays/nights.

            There is a reason that our elderly are stuck in awful situations- providing long term care for an individual is crazily expensive. Paying someone the equivalent of $5 an hour for 24 hour care comes out to ~$44,000 a year- without any capital expenses, emergency expenditures, medicine etc. Institutional care is the only way to minimize enough expenses to make it affordable for your typical family for any one with needs that exceed an hour or two a day.

          • Who wouldn't want to be Anonymous says:


            It might be interesting to note that this is almost certainly the exact reason that home care aids for the elderly are exempt from federal minimum wage rules.

            I don’t think it is used very often in practice, though.

          • keranih says:

            It might be interesting to note that this is almost certainly the exact reason that home care aids for the elderly are exempt from federal minimum wage rules.

            Were exempt. According to NPR, that changed today. (Or yesterday.)

          • Who wouldn't want to be Anonymous says:

            Wait, really? Damn you Congress, you can’t leave things alone long enough for random factoids to be current the first time I try using them.

          • RCF says:

            BTW, AIDS is a disease. People who help other people are aides.

      • Tracy W says:

        The autistic person is also using their basic income to pay for luxuries like food and water and a place to sleep indoors. How much is left over for paying a nurse? Who must then pay taxes on that income to fund the UBI.

    • magnetick says:

      Sorry to be flip, but I think they’re called parents (and even parents end up paying for the privilege!). This part of the piece stuck out to me because it sucks that somebody disabled has to use up their sweet sweet UBI money on boring basic services that others do not. Though, I can’t really see how that can be helped.

      The optimistic part of my brain says that once a good UBI scheme is in place, maybe the costs of caretaking will be reduced and it’ll come out in the wash, but the pessimistic part thinks that is definitely not possible.

  32. Nathan says:

    Abortion derail incoming. Skip if you don’t want to go off on this particular tangent.

    So… I get that Scott’s perspective is that “sentience” meaning some mixture of intelligence and/or self awareness is what grants a being a moral right to not be killed. I get that he says “Yes, an unborn human child is in fact an unborn human child. But it’s still totally okay to kill it because it’s not very intelligent yet and that’s the thing I care about”. I very much don’t agree with it, but I get it.

    But surely the expected future sentience of a being matters too? Imagine a wizard turns you into a chicken, but only for 24 hours. Is it more wrong to kill and eat chicken-you during that 24 hours than any other chicken? I think yes. Or suppose two people are in comas, but one is highly likely to make a full recovery while the other is going to remain a vegetable. Is turning off the life support for both of them the same?

    So shouldn’t the fact that a fetus will grow into an adult person impact the relative value of it vs a cow?

    (The same argument applies to a fertilized egg, yes. It does not apply to a sperm or an unfertilized egg – without the conception, they aren’t going to grow into anything)

    • Anon says:

      “without the conception, they aren’t going to grow into anything”

      This is a weird distinction to make, for a utilitarian, equivalent to “do you pull the lever (and kill one person), or do you leave it as it is (and kill five)?”

      There isn’t this strong distinction between action and inaction. If you have a moral obligation to cause potential people to exist, that applies just as much to unfertilized eggs as it does to fertilized ones.

      (FWIW, I think the relevant distinction between wizard-chickens and fetuses is that wizard-chickens were, at some point, actual people.)

    • Wrong Species says:

      I don’t see why it doesn’t apply to sperm or an unfertilized egg. Yes, without conception they aren’t going to grow in to anything but your original point was about expected future sentience. That sperm may not be anything right now but it still has potential.

      • Nathan says:

        The expected future sentience of a sperm is not very high at all. We’re talking about what we can rationally expect, not what is potentially possible. Yes, combined with an egg, a sperm can grow into a person. But the vast majority of sperm are never going to combine with an egg.

        To return to the wizard chicken comparison, that would be kind of like saying that if a wizard can turn a person into a chicken he can probably turn a chicken into a person so we can’t kill any chickens.

        (I don’t actually believe that ‘expected future sentience’ matters fwiw, I take a much stronger pro-life position. Just trying to question Scott’s position on its own terms.)

        • RCF says:

          Most conceptions don’t result in a live birth. How likely does becoming person have to be? Is it okay to destroy frozen embryos, since they’re probably not going to grow into a person?

          If you use contraception over several months, you’ve prevented a potential human from coming into being. Is that immoral? If decreasing the expected number of humans is immoral, then a few months of chastity is more immoral than an abortion.

          “To return to the wizard chicken comparison, that would be kind of like saying that if a wizard can turn a person into a chicken he can probably turn a chicken into a person so we can’t kill any chickens.”

          In this hypothetical, can he create a new person out of a chicken, or can he turn any chicken into the person he turned into a chicken? If the former, then it’s not wrong to eat a chicken because no previously existing person is affected. If the latter, then it’s not wrong to eat a chicken (even the one that was created out of a person), because because there’s no clear sense in which the chicken “is” the person.

          I don’t think that wizards turning people into chickens is a very useful hypothetical, as we have to assume such wild counterfactuals that our normal reasoning doesn’t apply.

          • Zippy says:

            How likely does becoming person have to be?

            In this hypothetical moral framework– which I’m fairly certain no one actually uses¹ — I’d imagine that the wrongness is directly proportional to the likelihood. I.e., killing 1 person is 1 wrong. Killing 2 people is 2 wrong. Destroying something that had a .5 chance of becoming a person is .5 wrong. (This assumes we don’t care about lifespan)

            This hypothetical moral framework runs into problems where you have to factor in all the children the thing would have had had it turned into a person. I sometimes wonder how the numbers would work out, but then I remember I don’t care.

            1: I should not make this prediction; I’m also fairly certain that there is a rule like Rule 34 but for moral philosophies. Also many people claim to have this moral system if they have a dislike of abortion but don’t quite know why.

        • David Kinard says:

          Yes, this is the thing about the pro-choice position I find puzzling. Pretty much every argument for pro-choice also works for infanticide, but people have very different moral views on that.

      • keranih says:

        I don’t see why it doesn’t apply to sperm or an unfertilized egg.

        Because if you leave the egg or sperm alone, and do nothing to it, the cell eventually degrades, ceases functioning, and dies on its own, having done everything it was designed to do (failing the opportunity to combine into a conception). The potential of an unfertilized egg is that of an non-cancerous cell on the wall of your gut – eventually, it un-becomes. Your intervention will not change this outcome.

        If you leave the conception alone, it becomes an adult human being. Your intervention will (largely) not positively affect this, but you can destroy it.

        (For what it’s worth, I used to hold to the idea that unfertilized eggs & sperm were a sub-class of ‘potential life’ – and they are, I still suppose, in the way that a non-cancerous cell is. Now I see the possession of a full set of DNA and the mechanisms needed to grow into a thing that can write rap lyrics and sew patches in pants and stand up and say “Here I stand” without any intervention from any person to be a different thing than a cell on a gut villi or an egg or a sperm.

        • RCF says:

          Besides the attempt at an omission/commission distinction and teleogical terminology, there’s the fact that an embryo does in fact require the intervention of person to become a person.

        • Earthly Knight says:

          I am given to understand that parents who believe their infants will germinate into adults if left to their own devices are commonly charged with murder.

    • Anonymous says:

      Imagine a wizard turns you into a chicken, but only for 24 hours. Is it more wrong to kill and eat chicken-you during that 24 hours than any other chicken?

      Sure. But this is because killing the chicken also kills me, a human who wanted to keep living.

      Suppose a wizard points at a chicken and says, “in 24 hours, if this chicken is still alive it will turn into an adult human.” I see nothing more wrong with killing and eating that chicken than any other chicken. No human’s preference to live is being violated. If the human never comes into existence, it is never harmed. And nothing has a right to come into existence.

      • Anonymous says:

        I see a problem with this. Imagine you learn that the utility of everyone born from tomorrow onwards will be the lowest it could possibly be. Life will be the absolute worst experience imaginable for them – the entire crop of future humans. Imagine you also learn that if you violate the preferences of one currently living individual by the tiniest amount imaginable, then not only will the everyone-is-miserable disaster be mitigated but it will be reversed: everyone born from tomorrow onwards will have as high a utility as it is possible to have.

        Should you violate that person’s preferences? It seems to me that the answer is quite clearly ‘yes’. I can also think of an example in the opposite direction, though, where concern for current humans clearly outweighs concern for future humans, despite the utility of the latter being higher. Which is one reason I doubt the validity of the straightforward, ‘obviously correct’ answers that utilitarianism purportedly gives.

        • Anonymous says:

          Should you violate that person’s preferences? It seems to me that the answer is quite clearly ‘yes’.

          I agree. I don’t think this contradicts what I wrote above. I’m not claiming that future people’s lives have no moral weight. I’m claiming that we have no obligation to bring specific new people into existence.

          I think if someone is going to come into existence, you have an obligation to not make their future existence miserable. To borrow from another thread, this is why women have a moral obligation not to drink a lot of alcohol during pregnancy.

          But if by some action you can cause someone to come into existence who otherwise would not have existed, you don’t have an obligation to bring them into existence. For example there is no obligation to have a lot of children. This is why it’s OK to kill and eat the chicken who otherwise would have turned into an adult human.

          I can also think of an example in the opposite direction, though, where concern for current humans clearly outweighs concern for future humans, despite the utility of the latter being higher.

          This is a tangent I guess, but I’m curious what scenario you are imagining here?

          • Anonymous says:

            Okay, that I can agree on.

            “This is a tangent I guess, but I’m curious what scenario you are imagining here?”

            Long version: you have a magic button that will kill a billion people. It will also cause there to be an extra billion people total born in the future, whose utility will be identical to the billion you killed, except for one person, whose utility will be higher by an amount equal to the smallest unit of utility possible. Should you press the button?

            Short version: should you kill all the sad people and replace them with marginally less sad people?

            The answer to both questions, in my view, is ‘obviously no’. I think this is true even if you account for things like “what about everyone who will miss them”.

          • Anonymous says:

            should you kill all the sad people and replace them with marginally less sad people?

            Of course we agree that you shouldn’t. But I think you can agree with this and still be a utilitarian. When you are totaling up the “goodness minus badness” of a particular course of action, just make sure you account for the high badness of deaths of people who don’t want to die.

            That is, define utility as a function of the entire future history of the world rather than as a function of the state of the world at some particular future time.

        • nohbdy says:

          My preference that all future humans not be miserable is greater than the tiniest amount imaginable. If I were a utilitarian, that would justify violating a living person’s preference by the tiniest amount imaginable. Your thought experiment could be made more inconvenient for the utilitarian by specifying increasingly large violations and stipulating that the current population, on average, actually wants all future humans to be miserable, and that this preference is caused by the current population’s values and not some mistake of fact or failure of analysis. This would prevent the utilitarian from justifying the violation on the basis of humanity’s CEV. In fact, the utilitarian might choose to bite that bullet.

          I, however, am a nihilist. To justify violating the preference of the living humans, it suffices that I, personally, think the future where all humans are miserable is aesthetically awful.

    • sweeneyrod says:

      Only a small percentage of fertilized eggs turn into babies. A (even smaller) percentage of unfertilized eggs turn into babies. What criterion are you using to decide that the first are destined to grow into humans, but the second aren’t? What is the qualitative difference between the cases?

    • M.C. Escherichia says:

      > Imagine a wizard turns you into a chicken, but only for 24 hours. Is it more wrong to kill and eat chicken-you during that 24 hours than any other chicken?

      The question is under-specified. What is actually happening to my mind during this time? For the wizard to restore me 24 hours later, my mind-state must have been stored somewhere. Apparently you imagine it being stored in the chicken. It’s the destruction of my mind-state that matters, so there is no difficulty in saying it’s wrong to destroy the vessel that is (somehow) holding my mind.

      If, on the other hand, my mind is stored on the wizard’s USB stick, and he has these awesome powers over matter, then he won’t even need the chicken to restore me later. The chicken is then irrelevant. Erasing the USB stick though is murder.

      > Or suppose two people are in comas, but one is highly likely to make a full recovery while the other is going to remain a vegetable. Is turning off the life support for both of them the same?

      Minds can be paused; e.g. dreamless sleep is essentially this. But most paused minds will restart. A mind that can never restart is already lost, already dead. Whereas killing the mind that will restart later is like killing a sleeping person. Again what matters is the destruction of minds that already exist.

    • Earthly Knight says:

      But surely the expected future sentience of a being matters too? Imagine a wizard turns you into a chicken, but only for 24 hours. Is it more wrong to kill and eat chicken-you during that 24 hours than any other chicken? I think yes. Or suppose two people are in comas, but one is highly likely to make a full recovery while the other is going to remain a vegetable. Is turning off the life support for both of them the same?

      These analogies are bad, because in both cases you have a being who was previously sentient temporarily losing her sentience, which does not describe a fetus. It matters that both the chicken and the coma patient have an established identity and relationships, and a suite of preferences, hopes, and plans that they would like and will be able to see fulfilled. The appropriate question is whether it is permissible to slaughter a chicken which has always been a chicken but will presently be transformed into an (adult) human being. Prescinding away from my views on killing animals, I’m inclined to answer in the affirmative.

      Edit: I see that anonymous already made this point above. Sorry for the redundancy.

  33. Adam Casey says:

    Thanks very very much for saying something I was worried I was a-bad-person-who-must-be-shunned for thinking. As so often.

  34. komponisto says:

    I remember Paul Nurse explaining, on one of the episodes of the Charlie Rose Brain Series, that psychiatric disorders could generally be regarded as misfiring or extreme versions of normal (i.e. non-pathological) psychological phenomena. Depression as an out-of-control version of ordinary sadness or grief is one example; another is that schizophrenia allegedly involves the sort of mental processes that normally characterize dreams.

    In other words, most mental illnesses are possibly “spectra”. If we’re not worried about a cure for schizophrenia stopping us from dreaming, maybe we shouldn’t be so worried a cure for “autism” depriving us of our Alicorns, Ozy’s, etc. (On the other hand, perhaps my modus ponens is your modus tollens…)

    • David Kinard says:

      I’m not so sure about the depression thing. One problem is that depression is also one of those things where a huge spectrum of phenomenon get lumped together.
      Severe depression, in my experience, really isn’t anything like sadness, or a more extreme version of sadness. That might describe the melancholic subtype of depression, but I’m not sure.

  35. Mark says:

    There are disability advocates who also raise objections to curing, e.g., deafness. The argument, as I understand it, is that the deaf experience is not merely equivalent to the hearing-abled experience E minus something, and therefore strictly worse than E, but is instead more or less incomparable to it; and, moreover, that forcibly curing deafness is culturally imperialistic, kind of like kidnapping Amazonian infants so they can be raised in a putatively superior industrial civilization.

    Since deafness doesn’t engender the sort of unrelenting hellishness and dependency that severe cases of autism do, I’d be interested in hearing your thoughts on the matter. (I myself am tentatively in favor of eradicating deafness in children, even at the real and regrettable cost to deaf communities. But then you have Two Worlds Collide-style issues that result from that…)

    • Scott Alexander says:

      I think I agree with you – curing deafness seems like probably a good thing, but deafness doesn’t seem to cause suffering to the same degree autism does so the issue bothers me less.

      Also, non-deaf/non-autistic people totally brought this problem on ourselves by mistreating deaf/autistic people so badly that they had to form their own insular understandably-paranoid subcultures. Maybe if we stop mistreating them for a few generations those will become less of an issue.

      • Peter says:

        The subculture thing: ISTR there’s the term “D/deaf” where “Deaf” means “part of the Deaf community” and “deaf” means “has hearing loss”.

        With autistic spectrum conditions; there’s an adult autism social group that I used to go to, and there was this convention I went to once, but I never really got into the whole explicitly-autistic thing. There are lots of subcultures though like various nerd/geek etc. ones that aren’t explicitly about that and which I think are probably majority neurotypical (certainly majority not-diagnosed-ASD), but quite a large part of that majority have more autistic traits than the general population average. I find myself identifying with those subcultures, not with autism-specific subcultures, and certainly not activisty ones.

        There are also some other groups which surprisingly turn out to be rich in people on the spectrum – there’s a trans* support/social group I go to where there’s at least two other regulars with Asperger’s diagnoses – there have been some events where the presumed-to-be-neurotypicals have been in the minority.

      • Murphy says:

        I don’t think the subcultures are just a response to abuse.

        if you’re deaf then drinking buddies who all sign as well and have a lot of shared experience make sense.

        If you’re somewhat autistic other somewhat autistic people can be a lot less stressful to be around because they don’t require you to make eye contact all the time, don’t get pissy if you don’t look at them while you talk while again, sharing more of your own subjective experience of the world.

  36. Stefan Drinic says:

    First off – as has been mentioned earlier in this thread, 80% of this debate is about tribal politics. Matthews is annoying. Autism Speaks is not a positive influence. Mind killing is a real thing. I’m going to try and ignore the tribal aspect inherent in this, so please try to do the same if you’re going to reply to this.

    That said – a lot of what’s written in this post argues from a transhumanist perspective in which a lot of issues curing autism or aspects of it wouldn’t arise because X or Y would happen.

    An example used in the OP is one of comparing the idea of curing autism with that of curing nerdiness. You can argue that nerds are, on average, happier than autistics, and end up providing more utility in general, but this argument has a number of problems:

    – Nerds and autists are (very probably) highly correlated, and a cure for the one would end up with a reduction for the other a lot of the time.

    – A counterargument to this could be ‘most nerds don’t chew off body parts in order to feel less so we can cure one and not the other’, but I don’t buy this as an argument, becauuuuuse

    – People aren’t going to differentiate between things on the autism spectrum.

    The third one is my main problem with the idea of a cure for autism becoming a thing.

    I think it’s fair to say that nonverbal, hypersensitive, epileptic and generally troubled people are going to want to be cured of their issues; if finding a cure for autism can help them, applying such a thing may well be useful. Fine, but this isn’t a very interesting point to make. What we should ask onward, after deciding that severe autism is worth being cured, is whether or not people would still want a cure if we already had ways to get rid of being nonverbal, hypersensitive, epileptic and other issues(digestion, obsessive compulsion, whatever.)

    I find it very implausible to say that because severe autists suffer immensely, which they do, a cure is a good thing because that way they’d stop. If I’m going to have to agree with ‘every decent scientist and mathematician was a nerd’ without any sense of irony, I can decide ‘every Newton and Tesla had autism’ and speak as much truth by the heuristics we’re apparently using. I’m not going to buy the argument that we could get rid of the issues troubling the severely impacted autistics but keep the geniuses, becauuuuuse

    – Most people don’t read blogs like these and aren’t very well-educated. If you’re going to find a way to cure every form of autism, and tell young/expecting mothers that you can get rid of it with some kind of injection/pill, an enormous amount of women would choose to forcefeed their kids that shit ASAP, whether or not their child would end up a severe autist or someone with PDD-NOS or Asperger’s. As long as mothers are going to be protective and people in general undereducated, an all-purpose cure for autism is going to end up equivalent in autism going extinct.

    Finally, the point illustrated in is very good. Severe autists being caught up in severe suffering is very true, but genetics is a messy business, and even something as simple as ‘try to make sure people don’t end up living in a constent state of sensory overload’ may end up being a problem.

    • Scott Alexander says:

      The way I model this is a cross between the sort of copy-number issue here and something like mutational load. Those sound less hard than some other architectures to treat without causing too many problems.

      • Stefan Drinic says:

        I kind of addressed that in my post already, though. The chances of a worried mother deciding to keep/not treat such a child seem very low. Knee-jerk reactions are still a thing, and I think that the vast majority of people will decide against taking risks rather than in favor of it.

    • PDV says:

      There’s an easy reply to the SMBC argument: Make people smarter, healthier, and longer-lived, and let them , who are better-equipped to deal with these problems, figure out what other things should be optimized. I’m reasonably confident that applying this logic any time in the last century would have the arc of our collective moral system stay in approximately the same track, just moving more quickly.

      • Orphan Wilde says:

        The first and only optimization I’d make, given control of everything, would be to fire all the people whose jobs are theoretically optimizing everything. I’m not smart enough, I know for a fact none of you are, and the fact that you (the royal you, not the personal you) think you are just proves you’re too dumb to know just how dumb you are.

        Which is to say, anybody who wants to be in charge, under no circumstances should be allowed to be.

        As for the arc of our collective moral system, well, getting there faster is only a good thing if it’s going to a good place, a question we, in the middle of that arc, are in a uniquely bad position to judge.

        • Stefan Drinic says:

          We’re talking about the people who’d optimize the gene pool for whatever genes would be deemed optimal here, as per the comic I linked.

    • Gbdub says:

      “most nerds don’t chew off body parts in order to feel less so we can cure one and not the other’, but I don’t buy this as an argument, becauuuuuse

      – People aren’t going to differentiate between things on the autism spectrum.”

      On the one hand, you assert that no one will differentiate between anything on the autism spectrum and “curing” autism will necessarily mean eradicating nerdiness. On the other hand, you, and pretty much everyone else in this thread, is already differentiating pretty well (of course we should cure hand chewing, of course we shouldn’t criminalize quirky).

      And we already do this in society – consider myopia, a mild disability. LASIK is a pretty good cure, but we don’t have a problem with people who prefer how they look in glasses wearing them. Heck, you can leave your vision totally uncorrected if you prefer, as long as you don’t try to drive. We have pretty good prosthetic feet, but if a guy with no feet prefers a wheelchair we’re ok with that. We have pretty good breast implants, but we don’t force them on people post-mastectomy.

      I mean, we seem to be generally getting more and more tolerant of various quirks and unusual preferences – why do you suppose that would suddenly reverse once we have a cure in hand for autism?

    • David Kinard says:

      But genetic engineering for transhumanist purposes is going to be a long, slow process. Of course, it has enormous downsides if put in the wrong hands. Which is exactly why people need to start talking about the ethical goals of genetic engineering. If ethical people don’t do it, unethical people will. People are very opposed to it generally because they fall for the naturalistic fallacy that human are supposed to be a certain way, and separate genetic engineering from every other attempt to improve.

      Outlining a goal for genetic engineering, which done correctly would be about both improving the subjective experience of metahumans and expanding it, is important, or else all the important research will be done by governments with sketchy motivations.

  37. Peter says:

    I’ve got an Asperger’s diagnosis, and find myself somewhat anti-anti-cure. Although what I find myself fantasing about is a treatment – ideally I’d have a dial, but something you can take that acted about as aspirin or caffeine or ethanol and wore off about as fast would be lovely – something faster than my citalopram, please. Also, that Wakefield guy was a complete scoundrel on multiple levels and his work was worse than worthless, but if by some conterfactual it turned out that mercury in vaccines really did cause autism I’d be all for banning it pronto.

    I think that cure/anti-cure attitudes correlate with severity/diagnostic category less than you might expect – obviously some people are too impaired to have or express opinions, but apart from that… Ozymandias mentions people with quite severe impairments, or histories of the same, being quite staunchly anti-cure. I think that are a few more factors. One – if you’re surrounded by people with bad attitudes, then that might look like the primary problem, but when you’re in a weird liberal bubble where everyone is completely accepting and you still have problems then you might see things differently. A second factor is probably just personality; for whatever reason some people seem to be of the crusading type and anti-cure activism looks like an outlet for this. Third; there’s the meaning and purpose factor – crusading against prejudice etc. is a way to give your life meaning and purpose (which may be lacking if you find yourself blocked from some of the usual outlets). For me, I suppose Plan A for getting my “meaning and purpose” fix has been to do stuff For Science!, on the one hand a lot of the traits sort of help that (although there’s nothing like doing a PhD in a research group full of very smart people, all more neurotypical than you, to make you feel that Asperger’s is overrated as Science Fuel), on the other hand, a lot of the other traits can work against that (hello executive dysfunction). Which I suppose is why I want a dial.

    (I suspect there might also be a touch of “sides” about this. Anti-cure attitudes I think are part of the whole capital-S capital-J Social Justice thing, and I’ve found myself against that. Partly due to their attitudes on the Great Dating Mores Debate. So I have a dodgy ulterior motive for being anti-anti-cure. I don’t think this is a large factor, but it’s there.)

    • Justin says:

      I’m not sure the weird liberal bubble you’re thinking of actually exists in reality in large enough numbers to be countable. Aside from the name brand anti-autism activism groups, some of the environments that I’ve seen be quickest to either demonize or just completely misunderstand autistic people are those which are otherwise nominally liberal. The only cohesive environments that I’ve ever known to be especially accepting of autistic people is groups of autistic people, and it’s the self-advocacy groups that are most loudly specifically opposed to the cure rhetoric, despite knowing firsthand that there are things that don’t go away just because you’re surrounded by people who get it for once.

      • David Kinard says:

        It definitely does. Hang out in West Philadelphia some time. One of the few places where “anarchist” is a major political affiliation, and openly admitting to be a republican is like wearing a swastika. There are other areas or neighborhoods in cities with what I imagine is a similar political climate. These tend to be neighborhoods that are “gentrifying” and magnets for musicians, artists, activists, and other over-educated, under-employed types.

    • Jeremy says:

      Can I ask what your symptoms are? I am always surprised by how little autism shows through in writing. I always find myself oscillating between feeling like I’m obviously on the spectrum, and feeling that I only vaguely fit the symptoms. I feel like I have a decent social sense (I can feel social norms/emotions/reactions), and I can tell when people have autistic social mannerisms as much as anyone else. But while I would expect autistic people to be just as distinguishable in writing as in any other form of social communication, I have found to my surprise that I totally can’t see the distinction.

      Would you agree with my assessment that you don’t feel at a disadvantage or even out of the ordinary in the way that you communicate through writing? How does writing feel to you vs spoken communication? Is it really just the body language that’s different?

      • Stefan Drinic says:

        I’m obviously not OP, but I do have an Asperger’s diagnosis, and my psychiatrist once told me that Asperger’s is essentially diagnosed by looking for autistic traits and finding everything except the verbal problems to pop up. So, while I’ll leave it to Peter to write a full answer, I feel safe to say that aspies are just as able to write well as people of equivalent intelligence, and that you’ll end up having much more trouble spotting us on forums and such.

      • Peter says:

        Reading various descriptions, I had quite a lot of that same oscillation – when I got the diagnosis, I was genuinely unsure about things and wanted to see what some people who knew what they were talking about thought. My areas of ability and difficulty can be a real mixed bag, and don’t necessarily fit any “profile”. On the one hand, I feel very alone in a crowd very easily, there’s an adult autistic spectrum social group that I (used to?) go to, and I think I was the second most likely person to be a wallflower there (the most likely person was pretty low-functioning), not engaging with the group – yet in terms of things like independent living, having a job, various groups of friends etc. I was one of the highest-functioning people there. Another random factoid: I perform at neurotypical levels on the “reading the mind in the eyes” test.

        Symptoms are a mixed bag – the important ones are the ones that got me to see various professionals at various times. When I was 9 or so my parents took me to see an educational psychologist – I was having social difficulties at school (or possibly my fellow pupils were having difficulties with me – I got on just fine with the teachers). One big thing was my way of talking, both in terms of tone of voice and also using too many long words etc. – being “inappropriately formal” (I’ve read one paper that found this was much more an Asperger’s thing than a HFA thing). There were also “coordination difficulties” aka being a klutz and bottom of the class at sports. The psychologist said I had more autistic traits than the average, but not enough for a diagnosis.[1] That said, the “Asperger’s” diagnosis was still new to psychology then and he wasn’t a specialist.

        Scroll forwards a couple of decades and I had a problem with generalized anxiety disorder which was proving difficult to manange. Partly work – I was having difficulties with teamwork and time management. Partly social stuff too (oh gods it’s complicated. Having AS seems to be a risk factor for not pairing up ever – one of my problems – but also seems to be a risk factor for marital difficulties (a common cause of adult diagnoses) and having kids on the spectrum (another common cause) – go figure). The diagnosis people said “definitely Asperger’s, possibly dyspraxia too, but we’re not qualified to diagnose that one”. There’s a whole bunch of stuff that comes under both headings, like clumsiness and executive dysfunction. Possibly the stuff that leans more dyspraxia-wards is the stuff I’m really frustrated with.

        Language wise, I have a very strong grip on semantics, but have all sorts of frustrations with pragmatics – the whole gamut from conversational turn-taking to dealing well with sarcasm, exaggeration etc. Some stuff on the internet can be difficult for me – in fact I often prefer face-to-face in-person conversation because the pathologies of the internet can really throw me. SSC is a good space that works well for me though.

        There’s this idea of a “spiky profile” – back at my ed. psych. encounter they gave me an IQ test and my subtest scores were pretty variable, especially in the “performance IQ” half, and in his report he mentioned the “spiky profile” by name. Apparently this is quite common not only for autistic spectrum stuff but for related stuff such as dys*ias, ADHD etc. – the fact that the profile is spiky seems to be more constant than any particular pattern of spikes and troughs. Odd ability differences show up in the strangest of places. During GCSE English Literature, I could do Plot, Character and Viewpoint questions quite easily but I was completely thrown by Style and Setting & Atmosphere – I could just about write a bad paragraph or two for those questions. Fortunately the exam structure meant I could dump those questions. Another odd one – I always had trouble with tying my shoelaces when younger, and even when I got the hang of it, until a few years ago they were quite likely to come undone during the day – yet I seem to be very good at cross-stitch.

        Oh yeah, and people with an eye for autistic-spectrum mannerisms tend to see them in me, too.

        [1] There was a phase in my life where I liked to quip that I was a few traits short of a diagnosis. Evidently not.

  38. Murphy says:

    “give him back his fricking mp3 player, you morons”

    This reminded me of a family friend who’s a specialist who works diagnosing autistic children. She regularly has similar but more profanity-laden exchanges with incompetent teachers.

    First an aside to be clear who I’m talking about.

    I feel that collapsing aspergers into autism may not have been the best choice for clear communication about it but lets imagine a scale where “non-verbal, screaming, attacking everyone, trying to chew off your own fingers” is a 10 while “good at math and makes cute hand flap motions” along with a few other more notable traits is perhaps a 1 or a low 2.

    There’s far far more people near the 1 than the 10. I don’t have figures but I suspect there’s some kind of skewed distribution.

    You don’t have to worry too much about the 1’s and 2’s. Most of them don’t suffer notably beyond struggling socially, most of them will go on to do quite well in life and never be diagnosed because there’s no point diagnosing something that doesn’t cause distress.

    I suspect people at this end of the distribution also make up the lions share of the tumblr “it’s not a disease” community. They probably wouldn’t have been casually diagnosed but either a specialist picked up on it or they went looking for a diagnosis.

    The 7’s and up tend to have been spotted early because even non-specialists can see the signs.

    There are lots of kids who are perhaps a 3 to a 6. Kids who can communicate but who have varying levels of problems. These are the majority of the kids she has to deal with. They’re not in such a bad state that it was picked up by non-specialists. In years past they would have just ended up with teachers deciding they were intellectually disabled. Often they’ll have been noted as being problematic or struggle in school because teachers and others know there’s something wrong but don’t realize it’s autism.

    A common symptom (as she put is) is that they’ll have a “thing”, more formally “Obsessions”, something that they care about a great deal. It might be lego, it might be spiderman, it might be electronics, buttons, clouds, almost anything but the kid will be consumed by it and it can last years, decades or more.

    So we come back to “give him back his fricking mp3 player, you morons”. When a child has autism and an obsession they want their obsession to be involved in everything. If it’s lego they’ll want to always be near lego. A lot of incompetent teachers across the country see this behavior and treat it as a dominance game.

    They assume it’s like a normal child trying to thumb their nose at the authority figure. So they take away the lego, or they take away spiderman and suddenly life is nothing but a battle. The child is constantly upset because lego or spiderman has been taken away while the teacher is constantly struggling with the child but now they’ve made it about dominance and won’t give up the fight.

    So a large part of her job consists of battering inept teachers over the head and saying something like “give him back his fricking mp3 player, you morons”.

    She has to repeat some variant on this quite often “He’s not doing this to fight you or to belittle your authority. He’s autistic. He cares more about lego than he does about you, me or his parents. Just let him have it on his desk or in his pockets or around his person and don’t get upset when he seems distracted by it”

    The child does better, the teachers and parents do better and everyones lives become easier.

    I can see why some people might still not want a cure. Think of something you care about, the thing you like to think about whenever you have free time. Perhaps art, perhaps philosophy. Would you want a pill that made you stop caring about it in exchange for really caring about the football, jersey shore and big brother like everyone else even if it meant you’d be likely to be suicidal or unhappy?

    • Scott Alexander says:

      “I can see why some people might still not want a cure. Think of something you care about, the thing you like to think about whenever you have free time. Perhaps art, perhaps philosophy. Would you want a pill that made you stop caring about it in exchange for really caring about the football, jersey shore and big brother like everyone else even if it meant you’d be likely to be suicidal or unhappy?”

      By far the creepiest treatment of this I have ever read is Vernor Vinge’s “A Deepness In The Sky”. You might find it interesting/horrifying.

      • Murphy says:

        SPOILERS FOR ANYONE WHO’S NOT READ “A Deepness In The Sky”

        Oh I adored that book.

        Are you referring to some of the “focused” at the end who refused further treatment after reaching the point of being able to understand and make their own medical decisions? That bit didn’t bother me so much.

        I found the whole idea of the manufacturing process for the focused quite disturbing.

        Though I can imagine some people finding the concept of something like that with an on/off switch appealing. Even the talk of the Emergent’s home planet with the lottery to decide who ends up “focused” at the end of university was pretty bad.

        minor spoilers “Schild’s Ladder”

        On the other hand have you ever read “Schild’s Ladder” by Greg Egan?

        One concept in that was that the polity had to produce new minds but once they qualified as citizens their minds were utterly immune to all outside interference unless they allowed it hence the system which tried out new mental variations had to be utterly paranoid about potentially producing minds which might turn in on themselves and experience endless pain because at that point nobody could help in any way for the remaining billions of millennia.

        Though the thing which made me shudder was the idea of some people applying mathematically provably self-sealing patches to their own mind such that once applied it was provable that no outside entity could convince you to remove the patch and no internal thoughts could lead to you choosing to remove it no matter how horrible the effects of the patch.

        • grendelkhan says:

          Oh, Greg Egan is the best about this sort of thing. The protagonist of Quarantine is a cop who has a set of onduty mods which sound an awful lot like being Focused, and I found the notion of spending a chunk of your life not-as-yourself to be more disturbing than expected.

          And the ability to pick up a damaging outlook also showed up in Diaspora, an outgrowth of some of the ideas in “Axiomatic”. From chapter six:

          It was an old outlook, buried in the Ashton-Laval library, copied nine centuries before from one of the ancient memetic replicators that had infested the fleshers. It imposed a hermetically sealed package of beliefs about the nature of the self, and the futility of striving … including explicit renunciations of every mode of reasoning able to illuminate the core beliefs’ failings.

          Analysis with a standard tool confirmed that the outlook was universally self-affirming. Once you ran it, you could not change your mind. Once you ran it, you could not be talked out of it.

          Or from The Golden Age, chapter “The Golden Doors”:

          “ ‘Mistake’ is such a simple word. An adult who suffers a moment of foolishness or anger, one rash moment, has time enough to delete or destroy his own free will, memory, or judgment. No one is allowed to force a cure on him. No one can restore his sanity against his will. And so we all stand quietly by, with folded hands and cold eyes, and meekly watch good men annihilate themselves. It is somewhat… quaint… to call such a horrifying disaster a ‘mistake.’ ”

        • anon says:

          I don’t understand where the Emergents were getting all the skilled people to focus. If having technical or scientific ability put you on the list of lottery candidates, it would be about a generation at most before everyone learned not to demonstrate any kind of skill whatsoever, meaning a total lack of people capable of sustaining their civilization. There’s a throwaway line that implies the Emergent homeworld would usually just replace focused people if they ever caused problems or outlived their usefulness, so they can’t have been in short supply. It seems like the only way they could plausibly get more was to capture people from other technological civilizations though, which only lasts as long as you have other inhabited worlds at the same (or greater) technological level in arm’s reach.

          E: I suppose you could get a stable of focused economists to work out the optimal chance of losing the lottery and being focused at, such that the expected benefits of education would outweigh the potential loss of being selected. But you’d have to set it differently for different majors and career tracks, since society needs different amounts of focused people in each field. But then you can’t let anyone know that each one has a different probability, because that would affect people’s decision making, and then you’d have to change the likelihood again…

          I wonder if the Emergent lottery was supposed to be a take on the one from Republic, since it seems like it would also have to be secretly rigged while pretending to be purely random.

          • Murphy says:

            I think the idea was that if you won the lottery and didn’t get focused you still had to get through life. If you were skilled and capable you could reach great heights. Note that the focused on the ships were all captives so nobody really cared about them but it’s hinted that focused on the homeworld could be reverted eventually.

            Think of it as like a military draft with candidates picked by lottery. If you survive you get some kind of payoff at the end.

            Vinge didn’t go too much into the homeworlds system but I can imagine people opting into a system where you wake up age 35 or 40 with a few million bucks (some fraction of your economic output while focused). If you choose a lucrative profession you or your family could become extremely wealthy. Considering that one of the focused was able to casually create items which according to the characters would be worth the price of a starship on some worlds… focused could make significant incomes.

            The scary thing is I can imagine that if such a thing were possible it wouldn’t be that weird for a real human society to adopt such a system.

          • Deiseach says:

            The scary thing is I can imagine that if such a thing were possible it wouldn’t be that weird for a real human society to adopt such a system.

            Not weird at all. Consider Apple and Facebook offering to pay for female employees to have their ova frozen.

            Work was not made for man, man was made for work! Is there any clearer signal? Use your most productive years to make money (for your employers) and then, when you’re over-the-hill in terms of employment prospects, you can have children and a family life.

            Leaning on people to have themselves upgraded for better productivity is the same kind of carrot-and-stick attitude; you’ll make a ton of money and have a nice jackpot waiting for you at the end of the upgrade, not-yourself, period while on the other hand, if you don’t avail of it, you’ll be out-competed by your colleagues and may indeed render yourself unemployable (why don’t you want a perfectly harmless, reversible procedure that is good for the company, good for the economy and so good for society?)

            Asking people to adjust their patterns of eating, drinking, and going to the toilet so they won’t interrupt maximum production-line setups with inconvenient and irregularly-timed bodily functions is now acceptable (and was defended by several commentators on here in a previous thread). That level of bodily control can easily be extended to mental control, if it’s not already; the ubiquity of being always in touch, always able to be contacted via phone and email so you never have ‘free’ time if the job can ring you at 12 o’clock at night or spring on you that you’ll need to work double or triple shifts for a big push over the next few days?

            It’s a very short step from that to “switch your brain into a different track so you don’t, and can’t, care about anything other than the job” for a short period of your entire life.

          • anon says:

            ‘it’s hinted that focused on the homeworld could be reverted eventually. ‘

            ‘It’s a very short step from that to “switch your brain into a different track so you don’t, and can’t, care about anything other than the job” for a short period of your entire life.’

            I wish I had the book in front of me now, but I’m pretty sure we get hints throughout the story that it’s very rare for the Emergents to ever deFocus anyone, and they don’t even necessarily know how to do it safely. Being drafted is statistically pretty unlikely to mean death or even serious injury in most cases, whereas Focus is basically permanent. The offer of deFocus seemed mainly like something they dangled over subject populations to get them to accept it until they were no longer useful, IE the case of Ezr Vinh being convinced to collaborate by the prospect of them eventually deFocusing his waifu

          • DensityDuck says:

            Keep in mind that the frozen-ova thing is not all it’s cracked up to be, as it were. Pregnancy success is a function of maternal age at gestation as it is ovum age, and implantation of an externally-introduced ovum has its own issues.

            In about twenty years look for a lot of lawsuits against Apple, Google, and fertility-preservation companies from women in their forties who’re on their tenth pregnancy attempt and their third miscarriage.

        • Kyre says:

          The bit about one of the characters applying a universally self-affirming modification was in “Diaspora”, wasn’t it ?

      • Bassicallyboss says:

        I don’t often experience emotions during stories except for sadness or melancholy–usually, any feelings come upon reflection. However, “A Deepness in the Sky” made me feel more emotion than even my own life usually does.

        (Deepness in the Sky spoilers may follow.)

        I had to put down “A Deepness in the Sky” a few times though, because the situation with the Focused and poor Qiwi’s plight triggered a very strong NO WRONG BAD NOT-OKAY NOT-OKAY STOP reaction that made me feel very angry and very vulnerable. It was very good, but I almost didn’t finish it. In the end, the situation was so horrible that I couldn’t deal with things staying as they were, so I had to finish and hope for a happy ending. (My first Vinge book, too, so the whole time I was literally biting my nails and dreading that the next page would reveal him as an author who likes to crush your hopes.) Only that and the Spiders kept me going. I had to see what happened with the adorable Spiders.

        It felt like being in a dream where your loved ones are about to be killed, and you can’t speak to call out to them, and you run to them but you’re heavy, moving in slow motion, and your stomach is knotted with worry. The end was when you wake up, sweating, and feel the knot evaporate, and the fight-or-flight slowly melt, and you feel glad for what didn’t happen, but mostly you feel exhausted from the experience, and lighter by thrice your weight for the vanished stress.

        • I like Vinge’s work, but that was one of two books of his that I didn’t finish because at some point they got too dark for me. I mentioned that to the author and his response was that he could write darker than he could read.

          Arguably one of my limits as an author is that I can’t, or at least don’t.

        • Murphy says:

          Have you read Fire Upon the Deep?

          You know that happy/light ending in Deepness in the Sky? If you read Fire Upon the Deep you realise that the ending was actually very dark too.

    • Deiseach says:

      Would you want a pill that made you stop caring about it in exchange for really caring about the football, jersey shore and big brother like everyone else even if it meant you’d be likely to be suicidal or unhappy?

      I don’t know; would you like having a meltdown because when you set the table (that was my job as a kid) it’s supposed to be green plate-blue plate-green plate-blue plate and there are two plates of the wrong colours together?

      It took me a long time as a child to work out that most people don’t stress themselves into stomach pains over two plates of the wrong colours being side by side.

      Oh, and the fun repetitive ritualistic compulsive actions/behaviours! I had to break myself of that as a young teenager (and again, nobody said anything to me about it because I didn’t tell anyone about it) because it was getting worse and worse, to the point of it would take me a long while to perform all the actions in the right sequence of movements and then copy them backwards (and then reverse forwards, and then reverse backwards the other way).

      If I’d let myself continue, that would have really been bad, so I made myself stop (with a lot of mental distress but I got there). Yeah, if there were a pill that made me stop caring about stuff like that, I’d take it.

      Edit: Why did you have to mention the football, was it because you know I’m stressing out over Liverpool’s new manager (mainly because he’s so perfect for us, it can only all end in tears and despair), did you want to upset me???? 😉

      • Murphy says:


        That sounds more OCD-ish to me that autism-ish to me though I’m not an expert, I get the impression people are less attached to OCD at any level.

        Ah childhood.

        Patterns were so important, things had to be multiples, or perfect fractions.

        As a small child I’d get quite deeply upset if the route home didn’t mirror the route out. Circular or alternate routes were no good and at age 4ish sobbing because I’d heard of multiplication but didn’t know how it worked and being deeply upset until someone explained it.

        I don’t think my childhood was so bad because by that point they’d already had a few kids with similar early obsessions and behavior patterns. Things aren’t so bad when you’re surrounded by people with similar internal experiences of the world.

        • Deiseach says:

          Pattern, routine, repetition. I still deal extremely badly with change, to the point that I fly off the handle and come apart so fast you’re liable to be hit by the shrapnel. I eventually bought all-white plates to break myself of the “it has to be green plate-blue plate” thing because honestly, objectively it’s ridiculous to be so rigid about putting goddamn sideplates on the goddamn table for the goddamn tea-time.

          A lot of how I function when interacting with other people is repression and suppression. I may be screaming inside my head SHUT UP SHUT UP JUST PLEASE SHUT UP YOUR VOICE IS ANNOYING ME TO DEATH when someone is speaking in their ordinary everyday voice that usually* doesn’t annoy me, but I don’t say that out loud (any more) 🙂

          *Usually, but very small amounts of stress or simply more environmental stimuli than usual because the place is busy and noisy or congested, and I react badly,

      • alexp says:

        Maybe this will make you feel better about it?

  39. Mary says:

    Three-quarters have eating problems ranging from “picky eater” to “will not eat food, good luck doing something about this”</I.

    I remember the NY Time "Think Like a Doctor" diagnosis where there were two: the immediate cause of the infant's problem was scurvy, and as a consequence, they realized he was autistic, not developmentally disabled.

  40. PJ says:

    > “The cost-benefit calculations are totally different. Nerds are probably unhappy, but less so than autistics….[].. You’ve got to make your own choice about where to draw the line, and I draw it somewhere south of nerds and north of severe autism.”

    I disagree, I don’t think this line should drawn at present or even in the near future. Its too hard predefining a line “what it takes to have a happy life”. MUCH more work needs to go into the genetic and environmental factors that differentiate those on the happyness-lifewinning spectrum; the successful CEO, an underemployed STEM graduate, and your MP3-player-loving-wall-punching patient.
    I am going to guess that actually the genetics on all three will be pretty close, so especially preselecting who is going to be the winner in life is not a good choice to make while they are still in the womb.

    > Faced with the choice of seeing the flood of human misery that I have to deal with every day continue mostly unabated, or having a pill that provides a quick fix to said flood, I wish with all my heart for the latter.
    Sad to hear you have to work with really suffering people. I don’t know what to say apart from they are lucky to have you in their lives.

    (and cheers Scott for the article, nice writing, I was literally going to write asking for your views on HFA/aspergers vs “actual” autism last week.)
    (and for another interview on the Neurotribes book:

    • Murphy says:

      This sounds like The Fallacy of Gray

      Lets take autism off the table for a moment and talk about some other conditions.

      Would you be happy if tomorrow someone came up with a cure for Epidermolysis bullosa? (kids who’s skin falls off generally suffering constant horrific pain)

      How about lesch nyhan syndrome? Severe mental disabilities and a tendency to eat their own faces and fingers.

      Its hard predefining a line “what it takes to have a happy life” but you don’t gain anything by just insisting that there can be no line, that no attempt should be made to make reasonable choices. That’s just calling everything grey.

      • PJ says:

        I will put it this way…I don’t think we as society are equipped to deal with drawing the line. Even defining what is “autism” was changed significantly in 2013 (DSM V). And, if we in the future had confidence to genetically say where is a good place to define the difference between a nerd, someone with high functioning autism (HFA)/aspergers , and severe autism, I would draw the “should cure” line so far south of nerds, it would out of sight.

        And, as for the second part that there should be a line “north of severe autism”, although this is an impassioned argument from Scott, I would suggest the medical community aim for a cure for each individual cofounding symptom (depression/ADHD/…) before hoping for a one shot cure for all.

        • Mary says:

          It does not matter whether we’re equipped. No matter what we do, we ARE drawing a line. Even if we draw it to include everyone, we’re drawing it.

  41. Murphy says:

    To add to my earlier post. I wonder how much this is a Schelling fence on a slippery slope.

    Of the people with diagnosed autism here how many wouldn’t want a cure but would be quite happy to have a pill which toned it down by 10%? Made it just a little easier to talk to other people or toned down the sensory distress while changing your thinking just a little bit?

    Of those who are diagnosable but have kids with much more severe autism: how many would like their kid to be on about the same level as themselves but wouldn’t want to do away with it entirely?

    • Justin says:

      Sounds like a bum deal to me. My sensory issues are relatively minor and I suppose I wouldn’t miss them if they were gone, but the overly empathetic way I think (yes, yes, that autistic people are emotionless robots is a oversimplification to the point of being completely backwards in many cases) is exacly why I don’t think the solution to the way the majority treats the minority in situations like talking to other people is to medicate the minority until they act “normal”. The social model of disability is like peak Let’s Address The Underlying Cause Rather Than Go For An Easy Fix, but I really don’t think I can ever support a model that works purely in reverse.

      • Murphy says:

        Right, lets include a pill which tones it up 10% as well then. If one of your kids wasn’t autistic at all would you want to feed them the pill until they were on the spectrum? Why/why not?

        I’m under no illusions about empathy, again though I don’t like that the term “empathy” mixes together 2 completely separate concepts, that of intuitively reading emotion in others from expression and behavior and that of actually caring about what others feel once you know their emotional state. Autism is extremely strongly linked with being poor at the former, not the latter.

        • Justin says:

          I might want that if the entire rest of the world was better adapted to accomodate them, but as things are, it’s still a profoundly disabling set of differences.

          It’s like how even today, even if one would be absolutely accepting of it in every way, it’s still kind of absurd to say you’d specifically want your kid to be gay. Why choose to make things that much harder?

          • Murphy says:

            I can think of some reasons. From my point of view my father’s not at all subtly autistic but is extremely high functioning. It’s quite heritable and of my siblings the one who’s not on the spectrum at all seems least happy/successful while the rest kind of blow the demographic trend lines out of the water in terms of academic and financial success and all have pretty good lives.

            Personally I’m kind of with Mai La Dreapta (higher up) in that I’d almost certainly want to tone it down if I had a kid with severe autism but at the same time I can imagining actually wanting a child of mine to be perhaps a 1/10 on the spectrum because I’m surrounded by people who’ve benefited significantly from being a *little* autistic in both my family and social life with the costs being fairly minor.

    • Peter says:

      Pill: Oh please please please! By which I mean I’d be calling them “the dratted pills” before too long, but that wouldn’t stop me taking them.

      To a certain extent I already have pills to deal with a condition very commonly found along side autism-related conditions – I have my citalopram for Generalized Anxiety Disorder. In fact, trying to get my GAD to shift was how I got diagnosed in the first place. Theoretically I could take a higher dose of the citalopram and have less GAD symptoms, but I don’t want the side effects. I could well imagine autism/Asperger’s pills having similar issues.

  42. Sarah says:

    So, about institutions, you really need to read this article:

    These are two autistic people who have been institutionalized and think all institutions should be abolished. And it is very instructive.

    *Part* of the problem is abuse. Being beaten by staff and so on. But that is only part of the problem. Part of the problem is that being an adult who is totally under someone else’s control in your day-to-day activities, as you are in an institution, is psychologically damaging in itself. Humans are not meant to be 100% submissive to authority figures, and if you are, you lose the skills necessary for surviving independently. A “good” institution without abuse would not solve that problem.

    • Marc Whipple says:

      I tried reading that and I just couldn’t. I don’t mean to sound lazy (and will understand if you think so anyway) but what is it they propose to do with people whose families can’t or won’t support them and who can’t take care of themselves?

      • Sarah says:

        Supported housing: i.e. the government subsidizes the apartment and the aides, but the disabled people have autonomy over their daily lives.

        • Marc Whipple says:

          And if the disabled people use their autonomy in ways that are harmful to themselves or others?

          • Sarah says:

            Here, I’m not sure if I’m representing “disability politics” standard positions, but I don’t actually think I believe in the “danger to self or others” thing. If a disabled person is violent, all the standard laws apply to them: self-defense is legitimate, committing crimes gets you arrested, etc. If they hurt themselves, honestly, that should fall under “shit happens.” It’s generally believed that less bad shit will happen to disabled people given basic living expenses and visiting carers than either keeping them locked up or letting them be impoverished. (It’s probably also cheaper for the government if done properly; homeless people use a lot of public resources.) But yeah, *some* people will use their freedom to hurt themselves. That’s what freedom fucking means.

          • Sarah says:

            Personally, I’m not a big fan of redistribution generally, but possibly the *strongest* case for it is providing for people who literally cannot work. Of all the government programs that should be eliminated, that’s pretty far down the list. And providing resources to the disabled in less authoritarian and abuse-prone ways is pretty much a straight-up Pareto improvement over the way we usually do it.

          • Marc Whipple says:


            I am at least somewhat empathetic to your position, but it’s not me you have to convince. If you are not free to fail, you are not free. And, by implication, if you are not free to starve, or to bleed to death because you chewed your fingers off, or to die of massive head trauma because you couldn’t stop banging your head on a big rock, you are not free either. No argument.

            But you’re not going to sell most people on that, and if the people in that interview think so, I feel quite vindicated about not reading it.

  43. Sarah says:

    Also: have you ever read autism research? It is pretty bad.
    I *dare* anybody to come up with a cure for autism. I dare anybody to come up with a genetic test for autism. These people are far too confused, and autism itself is far too heterogeneous, for that to even be a conceivable notion.

    My position on developmental disabilities is “sure, go ahead, if you find an *actual treatment*, treat ’em.”

    Phenylketonuria is an illustrative example. There’s a genetic disorder that causes people to not be able to digest the amino acid phenylalanine. If you have it and you eat phenylalanine, you grow up with severe intellectual disabilities. If you get put on a special diet from a very early age and stay away from phenylalanine, you have much milder cognitive problems. I’m pretty sure that phenylalanine-free diets are totally fine.

    Lots of nutritional deficiencies, environmental toxins, and, to take an extreme example, traumatic brain injury, cause cognitive disabilities; I am pretty on board with “parents should avoid these things for their children.”

    If it were the case that (some) autism was the result of a nutritional deficiency or a missing enzyme or something, intervening early to fix that problem sounds sensible.

    That is SO TOTALLY not where we are with respect to autism. We are still talking entirely in terms of behavioral traits. We are talking in terms of a “spectrum”. There is only the most tentative progress towards describing what autism looks like neurologically. I would be totally on board with trying to *understand* autism, but right now, talk of cure is ludicrous.

    Right now, a lot of “treatments” are basically abusive. (Giving someone neuroleptics because they misbehave is not treatment.) So I’m ok with the primary political message being “DON’T TREAT AUTISM, JUST LEAVE US ALONE AND GIVE US REASONABLE ACCOMMODATIONS.” I have issues with the movement myself — I don’t like the fact that there’s a party line and people will think you’re a bigot if you quibble with it — but I can sort of accept that for political purposes you have to communicate one thing, with one voice, everywhere, and if you’re going to communicate one thing about autism it should really be “stop abusing autistic people.”

    • Justin says:

      I think it’s telling that groups like Autism Speaks and Susan G. Komen for the Cure have so many parallels between them. Autism and cancer aren’t things that anyone can even really conceive of a cure for because that’s just not how they work. No wonder the people most loudly talking about finding cures for them are people who have emotional investments in them due to family (rather than direct) diagnoses and have subsequently turned them into big business.

      • Sarah says:

        I actually disagree on cancer being incurable, but that’s a long story. (been writing about it in more detail here: A major difference between cancer and autism, to start with, is that we know what a tumor is. We can cut it open and look at it. We know that Alzheimer’s disease causes plaques in the brain. We do not know anything on that level about what autism does to the brain.

        But agreed on the fakeness of Autism Speaks and Susan G. Komen.

        • Murphy says:

          I don’t get why anyone would think that Cancer will forever be incurable. In the last few decades alone there’s be massive advances with many treatments for many types of cancer.

          There are some genetic variants quite strongly linked to autism, you don’t have to fully understand the biology in order to link genes to a phenotype.

          I think the current model is a little like the current model for psychosis. Lots of risk genes where many of the individual ones which seem to confer some vague advantages since they appear to be selected for but you start getting disadvantages when you have multiple ones like a genetic game of “chicken”.

          • Sarah says:

            Then you are not talking about cure, you are talking about eugenics. Which has different ethical issues, different methodological challenges, and so on, and should really be a separate topic.

          • Murphy says:


            Maybe, maybe not. There’s a lot of interesting experimental things like gene therapy or treatments which provide alternate versions of the affected enzymes/proteins for various genetic conditions and we’d have to deal with the same eugenics problem whether it was autism or duchenne’s.

          • brad says:

            I don’t get why anyone would think that Cancer will forever be incurable. In the last few decades alone there’s be massive advances with many treatments for many types of cancer.

            I think the idea is that since cancer isn’t a unitary thing it can’t really be cured.

            A different way of looking at it is: have we cured bacterial infection? And if so, when did we cure it?

          • Murphy says:

            Cancer isn’t unitary but once you defeat a particular type of cancer it stays defeated when you come across it in new individuals, the same approaches continue to work.

            We’ve not totally defeated bacterial infection but we’ve turned it from a horseman of the apocalypse into something you only kind of have to worry about.


            Bacteria mutate and pass between individuals, we need to keep inventing new treatments but cancer, well even if we never invent another new treatment the anti-cancer drugs of today will still work on cancer patient 100 years from now. Every little victory is permanent and it’s not all that out there to think that we can chip away at the thousands of cancer types one by one until they all have good treatments.

          • Sarah says:

            When you’re talking about treatment, the ethical issues are almost entirely about risk-benefit analysis — is this treatment worth the adverse effects?

            When you’re talking about eugenics, the ethical issues are about the moral status of fetuses, and about second-order effects (e.g. will widespread selective abortion of disabled fetuses result in worse treatment of the remaining disabled people?)

            Someone could be pro-treatment but anti-selective abortion (“Killing fetuses is wrong, but treating disorders is ok.”) Someone could also be anti-treatment but pro-selective abortion. (“Autistics don’t want to be ‘cured’ and they shouldn’t have to be; but preventing autistics from being born is ethically ok because no harm is being done to actual living beings.”) The arguments are totally separate.

            The only aspect they have in common is the second-order effect stuff (“If you try to either treat autism or selectively-abort autistic fetuses, you’ll promote a popular perception that autism is bad and increase societal mistreatment of autistic people.”)

    • Free Range Platypus says:

      PKU is actually a good example, because it’s a case where we’ve found the mutations responsible and can screen for them. Although unlike autism they are rarely de novo so genetic counseling before marriage is a better choice for those at risk.

      We already, today, have genetic tests which can guide a diagnosis of autism based on copy number variants. There will soon be no need to treat autism when it can simply be prevented the same way we can prevent PKU or Downs Syndrome.

      • keranih says:

        There will soon be no need to treat autism when it can simply be prevented the same way we can prevent PKU or Downs Syndrome.

        Failing some massive breakthrough in the science in the last twelve hours, we can not prevent Downs Syndrome.

        We can – and do – kill the people who have it, before they are born, but we can’t prevent the condition from occurring.

        • keranih says:

          that is somewhat of an improvement of how it is/was often handled there/then:

          I am…unconvinced that then was worse than now just on that metric, but yes, it’s not like we invented killing unwanted offspring.

          I do wonder what we do, today, from necessity (+/- distaste), that our great-grand children will look on with such horror that they insist our names be stripped from buildings and memorials and all living memory.

        • Deiseach says:

          Exactly. “Preventing” Down’s Syndrome means, in many cases, doing pre-natal screening and then heavily suggesting to the expectant parents that they abort because otherwise their child will live a life of suffering and misery and probably die early, even though there are improved services that can help people with Down’s Syndrome and there is a range of disability; some people with Down’s are very disabled, some mildly so and can even go on to post-secondary education.

          But that’s expensive, so socially we’ve “solved” the problem by not letting such people be born, and by scorning and shunning parents who don’t abort (and talk about “moral obligation” to abort rather than burden society with the cost of looking after your defective spawn is ostracism and shunning and scorn).

          That kind of autism “cure” is certainly something to be avoided and rejected.

          • keranih says:

            My window of what is possible to legislate doesn’t include forbidding elective abortions of infants with terminal conditions. (Other people may disagree, and my moral ideals do include advocating against these actions, for reasons I find rational but won’t elaborate on here just now.)

            So I can see a social determination that we keep this option on the table. I do think we need to be far more careful in the execution of this option than we have been, and I see little justification for putting either autism or DS in the same bucket as lethal congenital contracture syndrome.

    • Michael Vassar says:

      A Baylor M.D. Geneticist and autism specialist who I discussed it with believes that L-Carnitine supplementation can greatly reduce the expected lifetime severity of what would otherwise be considered minor autistic-spectrum pathologies such as those of many of our friends.

      Agreed that 99% of autism research is worse than useless, to a degree far greater than is normal in medicine or even in psychiatry.

      • Sarah says:

        Right, it’s possibilities like that that I’d be in principle okay with if they panned out. (As voluntary choices by parents.) A major component of what bothers me is the object level — autism “treatments” with serious risks and no benefits. I think people’s intuitions about treatment would be notably different if it were something like “give your baby a harmless supplement.” It still wouldn’t be a no-brainer, though — to some extent my impression is that strengths and weaknesses cluster and you might give up desirable qualities when you give up these so-called “minor pathologies.” Once again, the object-level effects of a putative treatment matter.

    • Frank says:

      I don’t like the fact that there’s a party line and people will think you’re a bigot if you quibble with it

      I wonder if autistics are disproportionately represented among SJWs? Difficulty empathizing and spending lots of time reading the internet isolated from regular people being common characteristics?

      (Note: I have some difficulty empathizing with people and I spend lots of time reading the internet isolated from regular people, but I’m self-diagnosed neurotypical.)

  44. Deiseach says:

    I wonder if the increase in autism spectrum diagnoses is because we’re finally recognising what’s in front of us.

    What follows has no pretence of any kind of evidence-based rigour, it’s all personal experience, anecdotes, and wild speculation.

    My sister thinks I’m autistic.

    Or on the spectrum, at least. Possibly, back when they were still saying Asperger’s Syndrome was a separate thing, I would have been diagnosed as such, if Irish GPs had known autism was a thing.

    Why does she think that? Because, as she very recently told me, when she went to work in a Camphill Community years ago, the first thing she thought when meeting the villagers with autism was “It’s like living with [Deiseach]!”

    There is certainly a very strong strain of Asperger’s or something along that spectrum in my paternal family line. The more recent generations, who got diagnoses, get tagged with things like social impairment disorders. So this is not, on the face of it, an unreasonable notion that my sister had. (As TMI, the crazy on my father’s side of the family, quite aside from the happy coincidence that I turned out to be aromantic asexual, is one big reason I was determined never to marry and have children – I knew I’d be a dreadful parent and really, with our genetic heritage, yet another generation of fecked-in-the-head was not really necessary).

    And now I come to think of it, maybe that was why, when I was about 9 or 10, my mother brought me to see the doctor. Not our usual family doctor, and I couldn’t understand why, because I wasn’t sick. Looking back on it, I think perhaps she was noticing something off about my development and being concerned. But this being small town Ireland in the 70s, who the hell knew about autism? Even dyslexia was still years in the future, and kids were still being labelled as stupid or lazy, not dyslexic.

    The doctor recommended she let me get plenty of sleep and feed me Complan (again, I couldn’t understand why, as lack of appetite was certainly not a problem). Possibly he put down whatever lack of ‘normal’ interest and interaction I had to listlessness, due to growth and needing a tonic or nutritional boost.

    For years I had no idea why on earth this doctor’s visit took place, and it was only after my sister made her remark that I finally put two and two together. Perhaps I am getting 95 3/4, not 4, though 🙂

    So – is autism a disease or not, and if it is, do I have it?

    I don’t know. But I do know this: whatever I have, it doesn’t manifest as “introverted, likes math and trains, some unusual sensory sensitivities, and makes cute hand movements when they get excited.”

    Introverted? Yes, to the point of paralysis (I know that doesn’t come across here, where I’m telling all you strangers about intimate personal details, but in this context you’re not exactly real to me, and this is certainly not the ‘real’ me that people encounter in everyday real life. Pixels on a screen is what I’m interacting with).

    Unusual sensory sensitivities? Possibly. I hated being touched as a child and I still have little tolearance for it (to the point where it makes me laugh to read earnest young people going on about ‘touch-starvation’ and how dreadful it is not to have any human physical contact for weeks. I haven’t had any for decades, and I don’t feel ‘oh woe is me, I’m touch-starved!’) I can also hear dog-whistles, but I don’t know if this is because – contrary to popular belief – they are not inaudible to humans simply very high-pitched, or what. If anyone knows about dog whistles, enlighten me. (That’s another thing on my father’s side of the family, sensitivity to noise: my father used to react excessively – so I thought – to commonplace noises, like someone coughing or a door slamming. As I get older, I find myself doing the same “startled jumping over small noise” reactions).

    Maths and trains. No and no. Very much the contrary when it comes to maths. On the other hand, as I’ve mentioned before, when it comes to reading precociously, voraciously, voluminously and at a level of vocabulary higher than our age-cohort, my paternal family line will slaughter your tribe and drive off your women lamenting into enslavement 🙂

    Though when it comes to maths and music, I’m the exception in my family. Most of the paternal line are all musical – sing, play instruments, etc. up to levels of making a professional living from it (one genuine bona fide pop/rock star included!) and my father was self-taught and very interested in maths. So there is that, also.

    Cute flappy hand movements when excited. I do this, sometimes when I’m excited, more often when I’m stressed and anxious. You should see me in the throes of an anxiety attack (actually, no, you shouldn’t). It’s not fucking cute at all.

    Well, perhaps if you’re a pixyish gamine early 20 year old, you can pull off “cute” when flailing like a broken windmill. Believe me, it’s not at all cute when it’s a late middle-aged built like the back of a bus Irishwoman wringing her hands, beating her breast, and flailing her hands as if they’re broken at the wrist.

    I don’t know if I’m autistic or on the spectrum (it makes sense in a certain light, particularly with regard to me not having depression as such but rather mood swings, as my counselling session suggested). I don’t know if what I have is a disease. I do think it’s a problem (or a whole range of problems). If there was a fix, would I take it?

    I’d snap it up so fast it would be like a shark took your arm off at the shoulder, is my answer.

    That being unlikely, early diagnosis, intervention and support. If you’re functional and your autism does not hugely impact on your ability to live independently, you can argue about imposition of societal expectations etc etc etc. Part of that, I think, is because bad as things may be nowadays, in the past they were much, much worse. There is support, there are psychological strategies to help people, there’s at least the realisation that this thing exists and these are the effects you can expect and here’s how you work around them. If you, your parents, and teachers and everyone knows from an early stage that you’re autistic, that gives you a lot more options (no, really!) than having to wonder, forty years on, if maybe this is something (else) wrong with you?

    But when you’re like me – feeling like you’re a visiting Martian, you have so few points of contact with the people around you – then yeah, something to help you would be great. Pretending to be normal gets very, very tiring, having to keep it up all the time. Maybe if back in 70s small town Ireland there had been the knowledge that autism spectrum existed and the support to develop what I could of my personality to cope with the challenges of living in the world, my life would have been different. I don’t know, I can’t know.

    It would have been nice to have the option, though.

    • Marc Whipple says:

      A data point for you: When I was younger, I could hear dog whistles. I discovered that sometime after I turned twenty but before I turned thirty-six (which is how long I went between essays of the experiment) I lost the ability to hear them. I can still hear much better than most people my age when my ears are not stopped up due to sinus/allergy problems, but the super-hearing is gone. 🙁

      Actually, :/. While I wouldn’t say it was a sensory disorder, having very sharp hearing in a world where it seems like most people are half-deaf can be more than a little annoying, and not just for me. Ever heard the “Speak up, you mumbling bastards?” meme? Well, I don’t know that I mumble, but I speak in what to me sounds like a normal voice and to everyone else seems like I’m lip-synching.

  45. LPSP says:

    As someone diagnosed with Asperger’s during late childhood, I generally buy into the idea that Autistic conditions are the inverse of Psychotic or Paranoid-Neurotic conditions – hysteria, histrionics, narcissism, bi-polar depression and schizophrenia/schizotypal behaviour. Like the wings of politics, at the extreme end both families of conditions resemble one another. In politics, ultraleft and ultraright both propose totalitarian utopias, with a few key differences like a thought police on the left vs. ethnic cleansing on the right. In psychology, extreme Autistics and extreme Psychotics both struggle to treat people and objects differently and err in ascribing agency. The far-Psychotic mind assumes conspiracy theories and blames faulty lightswitches for deliberately sabotaging their job interview, while the far-Autistic mind is shocked by generally anything not originating directly from itself and assumes other people act without intent or a personal will.

    This is relevant because everyone has referred to someone as “paranoid”, or being “paranoid” at least once in their life. Everyone has also been paranoid or been called paranoid at one point. We all have probably known, encountered or at least observed one naturally suspicious individual in our lifetime. This is plainly related to clinical diagnoses of Paranoid-Hysteria but the two are not the same. There are correlations with paranoid and bi-polar depression among high-achieving artists in all mediums, just as there are highly-focussed counting behaviours correlated with scientific and mathematic achievement.

    Ultimately, society profits from individuals that veer somewhat from the norm on the spectrum of Nerdy-Oblivious to Artsy-Suspicious. Individuals also suffer greatly and present a net burden to society when they occupy extreme ends of this spectrum. Drawing lines with empirical research strikes my – admittedly autistic – mind as the most sensible solution to the debate. Identify those individuals whose personalities are in the red sectors and give them the cure.

    • Murphy says:

      I think it may be too simplistic to view the 2 as the inverse of each other. For one there are people with both autism and psychosis.

      More confusingly it appears that congenital blindness protects against psychosis (nobody with congenital blindness ever gets psychosis as far as we can tell) but is unrelated to autism.

      • LPSP says:

        I covered the similarities between the two conditions and how they converge in my post. The diagnostic process for autism and psychosis are much broader and poorly defined than our political left and right wing, and while in politics we have a name for individals on the extremes ends of either – totalitarians – there is no equivalent in psychological term widely used by professionals, describing the mutual errors in mentalisation. Were it the other way around, you would see people labelled as both politically left and right wing simulatenously, treat as doubling extreme by normal standards. Like National Socialists.

        That part about blindness and psychosis is very interesting however. Autistics do have finer and more intense senses, and IIRC there have been treatments of autistics with tinted lenses. There’s definitely a sensory component to both conditions.

  46. onyomi says:

    Is there any consensus on to what extent the explosion in autism diagnosis in recent decades actually indicates an increase in prevalence or is simply an increased likelihood of the same symptoms getting diagnosed as autism?

    • LPSP says:

      A very important question. It is also important to ascertain what could motivate a change in diagnosis. Parents attempted to give their kids an advanage in school, or trying to make them look special? Concerned psychiatrists, possibly with ideological concerns? I certainly know the former does occur.

    • Deiseach says:

      As I said, I think a lot of it is simply “Hey, this is a thing and the kid is not being a brat or fussy or picky!” The same as dyslexia revealed there was indeed a reason children found it difficult in classrooms and it wasn’t down to stupidity, laziness or lack of discipline.

      Until you know what the possible explanations for something are, you can only use what categories you have. When autism/autism spectrum/Asperger’s became part of the possibilities, then it gave doctors a reason to say “Perhaps we should refer Johnny or Mary for psychological assessment”, rather than “Well, just sit him down at the table and don’t let him go until he eats his greens!” or “She’s only looking for attention when she starts crying for no reason, ignore her”.

      • onyomi says:

        I am very interested in a variety of “supposedly recently got much worse for reasons, but maybe not” phenomena, like obesity, sperm count, and autism (in the case of obesity, there’s no doubt it’s up, but is just because we eat more and exercise less, or is there something esoteric messing up our microbiome so we feel more hungry?).

        I think in many cases it really is just a matter of being better at (maybe too good at) noticing things which were already there, though I think there are also genuine cases of new problems, like autoimmune disorders (allergies, asthma…), which I think are genuinely on the rise, probably due to excess hygiene.

        And I think it’s the genuine rise of autoimmune problems which probably lent a hint of plausibility to the whole “vaccines cause autism” thing: vaccines plausibly cause an immune reaction; immune reactions gone haywire can cause problems even like type 1 diabetes (immune system attacks your islet cells), which one generally assumes are mostly genetic; therefore, it’s plausible an immune reaction gone hawire during some critical phase of brain development might cause a problem.

        Not saying I think the above is likely (and in any case, I’d take a 1 in a million chance of my child getting autism over a 1 in 10,000 chance of my child dying of measles), but I can see how the rise of autism diagnosis may have created a negative synergy with the genuine rise of autoimmune disorders.

    • Anatoly says:

      There’s no consensus. A typical statement from an epidemiological article on the issue: “Whether and to what extent the identified ASD trend reflects improved identification or changes in the number and/or severity of population risk factors is of keen interest. The contributions of these two possible explanations are complex, difficult to measure, and not easily separable given currently available data.”

    • Douglas Knight says:

      Be careful about autism vs autism spectrum.

      Yes, there is a consensus: there has been no real expansion of full-blown autism. There are many more people diagnosed with autism today than 50 years ago. However, the expansion is not at the high end, but at the low end. There are more people diagnosed with autism+retardation today than before, but fewer diagnosed as just retarded. The total is unchanged.

      The expansion of Asperger’s is more controversial.

  47. Deiseach says:

    Matthews admits that “people have a image of autistic people as these completely nonverbal children banging their heads against the wall” …But as per Matthews and Silberman, this is just a consequence of the maltreatment these children receive in institutions

    Well, we here in social housing have one family with two autistic children (teenagers now) and they are looking for special adaptations to their house to provide for the boys’ needs. Their sons have never been institutionalised, have always lived at home and attend school, but one of them has to constantly wear a hurling helmet because he bangs his head so much he was doing noticeable damage not alone externally but internally, and this is by no means a unique case amongst our clients.

  48. Kiya says:

    Two things, first:
    And maybe the best option is that somebody develops technology that can change your brain type during adulthood, so that everyone has the option of experiencing life as an autistic person and as a neurotypical person and seeing which is best for them. Invent something like that and the problem disappears.

    Maybe a problem disappears…
    Preferences, as part of the brain experiencing them, are presumably subject to your brain-changing device. What if autistic-you strongly prefers to be autistic, but neurotypical-you strongly prefers to be neurotypical? (Or the reverse, but that’s less “moral quandary” and more “darn, sucks to be you.”) Do the two versions of yourself have equal personhood for purposes of rights/utilitarian calculus/whatever moral system, so that you are now forced to either timeshare your body, or kill your alternate self? Does it matter which way you were born? Would the hypothetical alternately-minded version of you deserve protections even if you had never undergone brain-changing? How extensible is the brain-changing device to produce mental states not on the autism-neurotypical axis, and do the answers to these questions depend on the particular mental state it induces?

    I think this is at least as hard a problem as “teleporter that duplicates you and disintegrates the one in the undesired location.”

    Second, on a more down-to-earth note, to those saying things like “I want a drug that cures X and Y symptoms without touching W and Z”… it is good to want things. But drug research as I understand it does not consist of drawing up precise contracts with the pharmacology demons. The choice at the moment is between supporting research aimed at better understanding the biological underpinnings of autism and how various chemicals might affect it, and not supporting such research.

  49. Emp says:

    One of the things that makes me see red is a defense of the idea that women shouldn’t drink during pregnancy.

    It’s their damn body, shut up and stop telling them what to do with it. They are fully within their rights to abort the pregnancy, so the question of a 0.01% chance of negative effects (and no it doesn’t matter even if that number was 1, 5, 10 or 15%) curtailing body rights is absurd. That’s a regressive, sexist, patriarchal norm that anyone should be ashamed of defending and I’m saying this as a person who isn’t particularly liberal or progressive and does NOT self-identify as a feminist, because I disagree with the philosophies of those who aggressively identify as feminists.

    Women aren’t baby factories designed to sacrifice their lives to slightly increase percentage chances based on dubious and often biased studies.

    • Murphy says:

      They are fully within their rights to abort the pregnancy but if they’re not planning to abort then telling someone to not drink is no more morally bad than telling them to not stare at the sun or not lick clocks with radium dials or to not drink when they’re suffering liver failure.

      It’s their body but they and/or everyone else is going to have to deal with the consequences of them damaging it and the child. Anyone who’s likely to suffer consequences (so anyone who might end up assisting caring for a maimed child) would seem to have an extremely good claim to a right to try to convince her not to drink while pregnant.

      She has an absolute right to make the final call. That does not strip everyone else of the right to try to convince her one way or another.

      If your mum or dad/husband or wife is suffering liver failure s/he has an absolute right to drink vimself to death but that doesn’t require vis dependents to remain silent. Vis rights don’t cancel out yours.

    • DrBeat says:

      It’s way more than even 15% and yes, it DOES matter.

      If there was a drug that was guaranteed to make your baby miserably and violently disabled for their entire lives, would you be completely okay with pregnant women taking it because “it’s their body”? I don’t think you would, and if you are, you shouldn’t be. This is one of many, many, many situations we encounter where one person’s rights have to be weighed against another, and saying that the rights of adult (popular, photogenic) women override everyone else’s in all cases is deranged. You have a right to swing your fists. Your right to swing your fists ends where my nose begins. Women have a right to drink or take drugs. Their right to drink or take drugs ends where someone else’s irreversible and debilitating brain damage begins.

      Also, how can you think things are “patriarchal” and not be a feminist? Those things are inextricably linked, it’s like saying “Now I’m no Communist, but the proletariat is being exploited when anyone else receives a profit!”

    • Scott Alexander says:

      Are we talking about a glass of wine here and there, or about downing a whole bottle of whiskey every day? If the former, I agree there’s no good evidence to show it does much. If the latter, the kid will get fetal alcohol syndrome and I don’t think people have a right to create people who they know are going to have those kinds of problems.

      • David N says:

        “I don’t think people have a right to create people who they know are going to have those kinds of problems.”

        Doesn’t that directly contradict what you wrote above about achieving an autistic child by repeated trials and abortions?

        • Wrong Species says:

          I think the difference is that everyone agrees a world in which no kid had fetal alcohol syndrome would be better.

          • Emp says:

            That’s not the same as “we will restrict people’s personal body rights” in order to avoid that result.

          • Wrong Species says:

            You have to realize that once you get pregnant, it’s not just your body anymore. You also have to consider the body of another living thing inside of you. I’m ok with restricting peoples personal body rights(to a limited degree of course) if it would eliminate fetal alcohol syndrome.

        • tcd says:

          There is a genetic vs. environmental difference. Think being born with a defective limb vs. making a normal limb defective.

          This is all adjacent to the recent stories of mothers being arrested for drug use during pregnancy.

      • Murphy says:

        Reminds me of an awful old joke:

        3 pregnant women were waiting in the doctor’s waiting room for an antenatal
        check-up and were all knitting garments for there respective babies.

        Suddnely the first expectant mother stops knitting, checks her watch,
        pulls a bottle of pills from her handbag and takes one…

        “What was that?”, the other two ask, curiously.

        “Calcium tablet. Good for mommy, good for little baby”, she replies, patting
        her stomach affectionately.

        Satisfied, all 3 continue with their knitting…

        5 minutes later, the second one stops knitting, checks her watch, takes a bottle of pills from her handbag and takes one…

        “What was that?”, the other two enquire

        “Vitamin tablet”, she replies, “Good for mommy, good for little baby” and
        she pats her stomach affectionately.

        All 3 smile and continue busily with their knitting…

        5 minutes later, the last woman stops knitting, checks her watch, takes a bottle of pills from her handbag and takes one…

        “What was that?” ask the other two…

        “Thalidomide. I can’t knit sleeves…”

      • Emp says:

        The problem is that the norm isn’t “don’t binge drink” (which as a suggestion should be a norm irrespective of whether you’re pregnant or not). The norm is “don’t drink at all” which is a destructive and sexist norm. Suggesting that all women’s lifestyle choices while pregnant should be geared around gaining or 1 or 2% percentage points for their children’s futures is just incredibly sexist.

        I detest it when people casually demand sacrifices of others at no cost to themselves and this is one of the best examples of that.

        • Randy M says:

          Speaking as a card-carrying Patriarch, rants in favor of dosing fetuses with alcohol are just about the best press imaginable for my kind of regressive, reactionary worldview. Thanks!

          • jeorgun says:

            I know you’re joking, but my certainty that being pro-life is the morally correct opinion has genuinely gone up about 20% as a result of that comment.

          • Randy M says:

            Serious except for the tone; I went for facetious to avoid breaking the rules of the blog.

        • Cauê says:

          Women help to enforce this norm at least as much as men. People also forbid family members, male or female, to smoke when there’s a baby in the house. People don’t think quantitatively anywhere near as much as we should, and least of all when sacred values are involved. I don’t see why sexism would be required to explain this.

        • Wrong Species says:

          If sexism has come down to “women shouldn’t drink when pregnant” then I would say they are doing pretty well for themselves.

          • HlynkaCG says:

            I know right?

            At what point do we call the war over and release the prisoners?

          • Emp says:

            Obviously that’s not the only problem women ever face.

            And that’s not really an argument for why a supposedly right thinking person can endorse this kind of toxic discrimination and sexism.

        • Chalid says:

          I want to support this post since it’s getting flak. There is no evidence that a drink a day has any effect whatsoever on the fetus. Women are told not to drink because doctors believe that women who hear “drink moderately” will just hear “drink” and go on a bender. It’s infantilizing as hell. As are a ton of the other pregnancy guidelines.

          (Smoking is really bad though, I fully support shaming that.)

          • Anonymous says:

            I think pretty much all advice given to people is more strict than necessary, on the basis that some people are bound to break the rules a little, and therefore since your advice can never be perfectly correct for everyone, it’s better to be overly strict than overly lenient.

            Two examples: use-by dates on food, and sex education.

          • Chalid says:

            I do think the degree of infantilization of pregnant women is far stronger than the infantilization inherent in food labelling – and I do think it is in part sexism. My wife had a baby recently so perhaps I am extra sensitive to this. It’s not just alcohol, there’s caffeine and a huge list of off-limits foods and activities for which there is dubious to nonexistent evidence of harm.

            That said, I don’t feel like doing the work and comparative research to distinguish this from conservative advice in food labelling.

          • Anonymous says:


            Perhaps. On the other hand, when we are talking about affecting a person’s entire life, right from birth to death, I think it is unsurprising that extra extra precaution is taken.

            And if doctors informed women that it was okay to drink moderately, for example, do you really not think that there would be lots of women who went on to drink excessively – thinking, oh, it’s only a little over the guideline, it can’t hurt? Some proportion of people will always ignore guidelines. I’m really not seeing the case for this being sexism.

          • Chalid says:

            Or maybe women will find themselves hedged in with a hundred BS rules, won’t be able to figure out which ones actually matter, and will guess wrong? Maybe they’ll think they deserve a cigarette to reward themselves because they virtuously avoided deli sandwiches all week? Or maybe paranoid nighttime self-monitoring of sleep positions will cause them to be extra-tired and get in a car accident. Maybe they’ll find out they were lied to about alcohol and then think that the cat litter rule sounds like BS too. Maybe the stress of going cold turkey on caffeine leads to bad stress-related effects on the fetus. Who knows?

            In general, people have finite willpower and it should be saved for things that matter. And being pregnant is hard enough without adding extra obstacles.

            To your point about sexism – it’s really hard to prove sexism in any context. See: any discussion of sexism. I’m not going to even try. But unnecessary lifestyle restrictions that only affect women aren’t obviously not sexism.

          • Anonymous says:


            I agree that there are obvious downsides to giving advice that is excessively restrictive – for all situations. As you said, it probably often does cause the person who has learned that one particular guideline is excessive falsely assumes another one is too.

            To return to my example of sex education – the advice given, at least when I was at school, was along the lines of “you must use a barrier type protection at all times. It doesn’t matter if you’re with a stranger or your spouse of fifty years. It doesn’t matter whether you’re having oral, anal, vaginal sex – all are equally capable of spreading STDs. Remember, when having oral sex, always use a flavored condom or a dental dam.” I often wonder how many unwanted pregnancies are caused by young people who first realize that dental dams essentially do not exist in real life (if you don’t have one, you can cut down the side of a condom! hahahahaha, this still cracks me up) and go on to infer that all contraception is equally unnecessary. It’s a low bar, but I bet this has happened at least once.

            You’re right that it’s difficult to prove sexism. But in this instance it’s extra difficult as we have nothing to compare it to, as men don’t get pregnant. Necessary or unnecessary, these lifestyle restriction (guidelines) are always going to apply to women only, for a very good reason.

          • Chalid says:

            Haha, when you first mentioned sex ed I thought you meant abstinence-only, and I decided not to go there 🙂

            I think if I were arguing for sexism affecting pregnant women, I’d make the case that parenting in general burdens women more than men, and then argue that the cause is partly sexism; and I would then conclude that whatever sexism led to the parenting work disparity was also likely to be at work in pregnancy. (e.g. something like “Women are expected to put the needs and desires of their children before their own needs of desires to a far greater extent than men are; this implies both that women will be expected to do most of the childcare and that there will be unreasonable expectations for their behavior during pregnancy.”)

            Anyway I think the hard part of that argument is demonstrating that sex differences in parenting effort arise in part from sexism. I’m sure there’s a vast literature on the topic but I have no idea what it says 🙂 Having admitted that, I’ll say that my uninformed opinion is that sexism does play a role