Monday, June 9, 2008

Questionmark Etiology: Ground Zero

Amongst some of my non-published writings, there is a 9,000 word essay that I wrote entitled Questionmark etiology: Ground Zero. This essay details the frustration I have had my entire life of wanting to know what caused my problems, more specifically my autism. I use the word "problems" rather than autism because this quest goes back to when I was 6 years old or younger before I had even heard of the term autism, let alone thinking i might have it or being diagnosed with it or being told of said diagnosis. This is not to be confused with a short fiction piece I wrote entitled "question mark etiology" at which deals with carpal tunnel syndrome and masturbation, two rather fascinating subjects in their own right (very big grin). This essay also deals with some of my experiences as the research subject of autism neuroscientist Eric Courchesne in some of his MRI studies. I have written a piece also which is on my web page, which details some of those experiences also.

I thought it might be interesting to summarize some of the points I wrote about in that essay which I wrote as a chapter of a non-fiction book I wrote a rough draft of. The Book's title is "Crying for Toasted Snow" because this is what I feel that parents of autistic children who expect their children to become typical kids through ABA, chelation and other treatments do. Complaining about things they cannot have. I believe this is also true of those in the neurodiversity movement who have the pipe dream of complete societal acceptance of everything involving autism and this solving everything, enabling autistics to function in the same manner as NTs. It comes from what is supposedly an old arab proverb, the discontended child cries for toasted snow. Also my essay on Bill Gates, Albert Einstein and Thomas Jefferson, is one of the chapters of this book.

In my essay, I write about how the fact I had "problems" was drilled into from age 5 and younger. I was seeing a psychoanalyst at the time. Psychoanalysis was the early intervention of choice for people with problems like mine in the late 1950s when I was 3 years old. My psychoanalyst had a rather interesting theory about the etiology of my problems. Since I had a sister who was 3 years younger than myself, she reasoned, at some point I must have seen her naked. I noticed that she was missing something that I had- a penis. She stated that I thought that my parents had cut off my sister's penis. Therefore I was worried that mine would be cut off as well and this was one of the reasons for losing my speech before I was 3 years old and my feces smearing and self-stimulatory and other autistic behaviors. This is referred to as castration anxiety in psychoanalysis. There is also its corollary, penis envy in women who end up on the analyst's couch.

Some years later, I was given a variety of psychologic tests including the Wechsler IQ test and the Bender-Gestalt test of visual motor perception. I had abnormal scores on these and this was indicative of some type of brain-damage.

In the summer of 1969 I saw the movie, "A change of habit" which dealt with an autistic child. This was the first time I had heard of the word "autistic" I was nearly 14 years old. The girl in the movie was 3 years old and had no speech, just I was told that I had no speech by both my parents and my psychoanalyst. I recovered my speech probably before I was 5. I asked my mother if this could be what I was autistic. My mother told me she had inquired about this possibility with some people and they rejected this notion. Not long after that another psychiatrist I was seeing as a teenager, after I stopped seeing my psychoanalyst, decided along with my parents that I had autism. But did labels like autism and brain damage tell me what specifically caused my problems, no. What area of the brain was dysfunctional in my case? What caused that dysfunction?

In the late 1980's I read an article in the L.A. times that part of the autism puzzle may have been solved. A researcher I had never heard of named Eric Courchesne had found in about 70% of autistics he had conducted MRI scans on had an area of the cerebellum that was smaller than in normal controls. These were lobules VI and VII of a part of the cerebellum called the vermis. I was absolutely intrigued. I wanted to know if this could be what caused my problems, damage to this part of the cerebellum. I contacted the Courchesne research lab. They were happy to find an autistic with intact intelligence to be a research subject. Nearly 20 years ago it was not thought there were anywhere near as many high functioning autistics of normal intelligence as there are today. I had the scan and I was told that I had this abnormality also, or at least the sizes of my cerebellar vermis lobules VI and VII were of average size for an autistic. The sizes of these lobules varied within the experimental group of autistics.

I was pleased with this relevation, but still it was not enough. I wanted to know more. I had read some stuff about the brain and its functioning. It seemed that it was very likely that autism was a problem involving the neurotransmitter norepinephrine. Also, an area of the cerebellum called the superior cerebellar penducle on which synapses coming from the dorsal tegmental bundle came from occurred. The dorsal tegmental bundle was one of the major brain tracts containing the neurotransmitter norepinephrine. I had read about the work of brain researcher James Olds who found that electrical brain stimulation of certain parts of the brain were reinforcing and some of these brain areas were referred to as "pleasure centers". I wondered if my self-stimulatory behaviors were due to something like this. Research on rats had shown that stimulation of the superior cerebellar peduncle was reinforcing. When the dorsal tegmental bundle was severed the rats continued to find stimluation to the superior cerebellar peduncle reinforcing. Could it be that norepinephrine was an inhibotory neurotransmitter and suppressed the urges of the superior cerebellar peduncle? This could be part of my problems. The few post-mortem autopsies of autistic brains showed lowered purkinje cell counts in the cerebellums of autistic persons. Norepinephrine and GABA are the only two neurotransmitters used by these neurons. This would increase evidence of norepinephrine involvement in the etiology of autism. I wondered could this be something worth looking into as an etiologic factor of autism and could MRI measurements of the superior cerebellar peduncles be taken in autistic subjects. I asked Dr. Courchesne about this. He said that it was an interesting theory. He stated that the cerebellar peduncles were only a few millimeters and too small to make measurements of in comparison to normal controls. I still think this is a hypothesis that might be worth pursuing and might be the cause of at least some autism. More scientific research might enlighten us.

Some years after I had my scan with the Courchesne lab. I was reading an article by researcher Joseph Piven that he believed Courchesne did not adequately control for age and sex differences between the autistic subjects and the control MRI scans. Due to budgetary limitations, the study that Courchesne published in the New England Journal of Medicine used hospital inpatients as controls. It would be too costly to find controls of comparable age and sex and perform MRI scans on them. Because the measurement techqniques were experimental there were no standard sizes of a cerebellar vermis for an adult man, adult woman, 12 year old boy, 10 year old girl, etc. It was quite possible that the smaller measurements in the autistics could have been an artifact of their being younger than the adult controls who might naturally have larger cerebellar vermi. This was a real disappointment. Of course I was an adult at the time, so maybe my having a smaller part of the cerebellar vermis could still mean something in terms of the etiology of my problems.

I am not sure, but i don't think that Courchesne's work has ever been replicated. My friend neuroscientist Matthew Belmonte, a former graduate student and protege of Eric Courchesne disagreed. He said there were several studies that replicated Courchesne's findings. He cited some examples. Most of these I have not read. One of the examples he cited though was of a Japanese neuroscientist named Hashimoto who published a study in the Journal of Autism and Developmental Disorders. I read the Hashimoto study and from my understanding of it, it would contradict what Matthew said. Hashimoto seemed to have measured the entire cerebellar vermis stating that it was abnormally small in autistic subjects. However, Courchesne's work had concentrated on just lobules VI and VII. There were ten lobules and only two of those ten were abnormally small in the autistic subjects. In one subject there was a smaller lobule VIII, though this was the only exception. So I don't think Hashimoto replicated Courchesne's work. I guess I will have to become more well read in the autism literature before I can make more determinations.

The final point is that my pursuits in finding out the exact etiology of my problems has been a tremendous disappoint. At age 52 I don't really understand anymore than I did at age 6.

I don't remember ever seeing my sister naked. Of course for castration anxiety to be the cause of my problems I would have had to see her naked right after the time she had been delivered and was taken home from the hospital. But so far, since I don't know what brain physiology mechanisms are involved, I can't help but wondering if maybe castration anxiety could actually be at the root of my problems, but I guess I will never know.

1 comment:

Anonymous said...


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