The Brain Book - Shadow Syndromes


	Shadow Syndromes RITA CARTER JAMES WAS A TERRIFIC BOYFRIEND - but he turned out to be a curiously unsatisfactory husband. “There was something wrong from the start “ explains Rose. “When were dating he used to turn up to collect me in an immaculate suit with a bunch of flowers and a plan of action - cocktails, theatre, restaurant - like something out of ‘50s etiquette book. And when he proposed he went down on one knee and produced a diamond ring. But we never became intimate in the way married couples usually do - it was as though there was some invisible barrier between James and everyone else - including me. The worst thing was that he would miss the most obvious emotional signals. Like he never seemed to know instinctively if I fancied sex. In bed he would always ask, really politely: “would you like to make love?”. Can you imagine what a turn-off that was, even when I did want it? “ The “something wrong” with James turned out to be a very mild form of autism. Autism is best known as a devastating form of mental retardation that locks its victims into a fragmented, nonsensical world and renders them utterly incapable of social interaction. But the idea of it being a single, severe condition is giving way to a more subtle view in which autism is a spectrum. Those at the milder end of this spectrum seem on first acquaintance to be - at worst - just a little odd. It is only those who live or work closely with them who know just how peculiar their thought processes are. As Rose says of James: “He was much cleverer than me on the surface, and you could have a perfectly sensible, intelligent conversation with him about something like the economy. But when it came to people he just didn’t know what they were about. He was hopeless to watch TV or films with - never got jokes, and if I snivelled at the end of soppy film he’d ask me if I had a cold” It is not just the autistic-related “shadow”conditions that are being identified more frequently. Many types of behaviour which were once thought of as mere personality deviations now attracting medical labels. Moody people are now frequently diagnosed as having “mild cyclical bipolar illness”; antisocial types have “borderline personality disorder”; worriers are tagged obsessive/compulsives and those who are excessively shy have social phobia. Serial adulterers, when they run out of ordinary excuses, opt for the “sex addict” label and a spell in a mental health farm. It is easy to scoff at all this - but in fact the proliferation of medical labels marks a fundamental shift in the way that illness - especially mental illness, is coming to be seen. The line between those who are “ill” and those who are just a bit “odd” is essentially arbitrary and right now it is shifting fast. The main reason for this is rising expectations. Ten years ago there was very little that could be done for a person with some mild form of mental disorder - you had to be practically suicidal to get help for depression, and the idea of giving drugs for shyness was simply absurd. But now we have new techniques which can identify subtle mental disease, and powerful drugs which hold the promise of doing away with it. So for the first time there is some point in slapping a medical label on conditions which would once have passed for normal Take shyness, for example. It may seem ludicrous to turn such a common and “normal” personality trait into an illness. But a person who is severely afflicted with shyness can be just as disabled as one with a recognised disorder like severe anxiety. “I didn’t even try to get to University when I was 18 because I was too scared of having to meet all those new people” recalls Mary, a bright and pretty thirty-year-old I met recently on an Open University weekend. “I got a job in the local library but I even found that unbearable - I blushed every time I had to ask someone to pay a fine. In the end I got a job working from home and that’s more or less where I stayed until last year”. What happened to change things for Mary was that she discovered a drug which, together with counselling , has changed her from a terrified recluse to a normal outgoing person, anxious to make up for lost time. Severe moodiness, like extreme shyness, is also starting to be seen as something that can - and often should - be treated rather than shrugged off as just part of a person’s nature. Even if the person who has the moods is prepared to put up with them , those who have to live with may not be so tolerant. A couple of years ago Jonathan and Serena were on the point of divorce due to Jon’s black moods and filthy temper. “One day I came back from the supermarket and he flew into a rage because I had forgotten to buy his favourite beer” recalls Serena. “He wanted me to turn round and go straight back to the shop. Instead I walked out and went straight to a solicitor”. The shock of a divorce threat tipped Jon into severe depression, for which he was treated, successfully, with drugs and cognitive therapy. The change in him after treatment made him, and Serena, recognise the behaviour both of them had always dismissed as “just Jon” was actually a sign of a milder form of depression which he had been suffering, on and off, for years.. Now he takes a low maintenance dose of antidepressants, his rages have disappeared and the marriage remains intact. Whenever a group of middle-class parents start chatting about their children, shadow syndromes soon crop up. Kids who would once have been called clumsy now have “mild cerebellar syndrome” or “developmental dyspraxia.” Bad spellers are “borderline dylexic”. Those who would once have been thought of as a bit slow now have “frontal lobe syndrome”; naughty kids have “impulse control impairment”; dreamers and those with butterfly-minds have Attention Deficit Disorder and the ones who wreck supermarket displays have Attention Deficit Hyperactivity Disorder”. Such medical labels are useful because they encourage early treatment. Childhood anxiety and shyness, for example, may respond to psychotherapy or certain types of antidepressants. Physiotherapy and training exercises may improve dyspraxia, and low dose Ritalin or similar amphetamine drugs may help the dreamy or butterfly-minded child to focus. This is not the case with Rose and James. Asperger’s syndrome is not easy to treat because it seems to be caused by a physical abnormality in the brain which probably occurs during very early development and is irreversible by the time it becomes evident. If a person with Asperger’s is very intelligent, they can often mask their inability to “know” what other people are about by “working out” what is going on, using logic rather than intuition. This often works quite well in the workplace and in casual social interactions, but it is rarely sufficient to make for a happy marriage. Rose gave up trying to teach James to read her mind and the couple wee amicably divorced a year ago.. She is now dating a man who invariably turns up late, dishevelled and breathing lager fumes .But he never has to ask her if she fancies going to bed. © Rita Carter 2007 - ritacarter.co.uk