=================================================== allism: an introduction to a little-known condition =================================================== by Andrew Main (Zefram) 2003-01-30 abstract -------- Allism is a congenital neurological disorder adversely affecting many areas of brain function. The condition is not widely known, having been only recently identified. This article is an introduction to allism, describing the mental and practical effects of the condition, and giving an overview of the current medical understanding. This article is aimed at the general public, though medical professionals may also find it a useful starting point. 0. table of contents ==================== 0. table of contents 1. introduction 1.0. an unrecognised condition 1.1. pronunciation note 2. effects of allism 2.0. direct effects 2.1. social impairment 2.2. the allistic mob effect 2.3. sensory impairment 2.4. general mental impairment 3. living with allism 3.0. social ritual 3.1. issues with text-only communication channels 3.2. problems with truth and falsity 3.3. use of computers 3.4. religion and belief 4. study of allism 4.0. development of allism 4.1. genetic predisposition 4.2. diagnostic criteria 5. postscript 1. introduction =============== 1.0. an unrecognised condition ------------------------------ Allism is a debilitating neurological condition which adversely affects emotional stability, sensory perception, self-awareness, attention, and many other areas of mental function. It is a developmental abnormality, arising from congenital neurological defects that affect infantile mental development. The effects are lifelong, and there is no cure. However, despite the wide-ranging effects, sufferers superficially appear normal, and can partially compensate for their deficiencies to lead nearly normal lives. Because of the superficial normality, allism has only been recently identified as a pathological condition. It has turned out not to be a rare condition; indeed, it is beginning to be recognised as alarmingly prevalent. Yet public knowledge is slow to catch on to these developments. There has been little research so far, and allism is still almost unknown to the general public, and even to mental health professionals. Because of the lack of common recognition, allism is rarely diagnosed. Indeed, most sufferers are not merely undiagnosed but may be completely unaware of their condition. As understanding of allism improves, it is expected that many people's eccentricities will turn out to be related to allism. 1.1. pronunciation note ----------------------- "Allism" is pronounced with a short initial "a" sound, as in the English word "allocate", unlike the vowel sound of the word "all". The "all-" part is the same Greek root that appears in the words "allophone" and "allergy". 2. effects of allism ==================== 2.0. direct effects ------------------- The underlying trait that makes people allistic is a dysfunction of the parts of the brain dealing with emotion. Allistic people lack the capacity to independently experience emotions. That is not to say they lack emotions: far from it, the allistic mind experiences emotions just like any other. The dysfunction is that the allistic person's emotional state is not determined by eir own thought processes but instead is borrowed from other people that are expressing emotion nearby. Emotional cues in tone of voice, posture, facial expression, and so on, cause the allistic person to automatically and unavoidably experience the same emotion being expressed. Of course, not all allistic people are affected to the same degree. What is described in the preceding paragraph is the extreme form of allism. There are many sufferers who are more mildly affected; they may have some capability to determine their own emotions, and are influenced by other people's emotions to varying degrees. Sufferers describe other people's emotions being merged with their own, creating an intermediate emotional state, rather than completely replacing their own emotions or being superimposed. In stressful situations, the received emotion is more likely to temporarily overwhelm the recipient's own emotions, provoking an immediate response based on the emotion rather than on analytical consideration. 2.1. social impairment ---------------------- Unsurprisingly, such a serious problem with emotions affects social activity significantly. Allistic people are very vulnerable in social situations: the possibility for people to project emotions into the mind of the allistic person means that they are easily manipulated, wittingly or unwittingly. Some people have indeed used knowledge of allism to prey on the allistic, using the allistic person's weakness to manipulate em into making unwanted purchases, or worse. Even when not being manipulated to eir disadvantage, an allistic person's lack of independent emotions naturally limits the contribution ey can make to a social interaction. Eir emotional input is limited to reflecting the emotions of others; even if ey enters a conversation with eir own emotional state, this is quickly attenuated by contact with others. 2.2. the allistic mob effect ---------------------------- Special problems occur where a group of allistic people interact with each other. Emotional states, once introduced to the group, get reflected back and forth between allistic people, in a feedback loop. With few or no non-allistic people to provide a damping effect, it is possible for the emotions passing among the group to become significantly amplified. Any change of mood can spread rapidly through the group, like a highly contagious disease, affecting all the allistic people as one. This leads to a mob effect, where the entire group of allistic people experience emotions that are unusually strong and are the same as what the rest of the group is experiencing. The group acts as one emotionally unbalanced and highly suggestible mind, and may perform acts that no individual member of the group would desire when not affected by the mob. 2.3. sensory impairment ----------------------- Most allistic people have moderate to profound impairment of the introspective senses. Many allistic people are unable to consciously examine their mental models of the world, and are unaware of their progress in learning new skills until they try them out. Many are only vaguely, or even only subconsciously, aware of their bodies' internal health, nutritional demands, biochemical state, and so on. Almost all allistic people are unable to tell the difference between real and psychosomatic physiological effects. Interestingly, some literature makes reference to "the five senses", referring to the external senses as if they are all that exist, or are at least predominant. While it is always difficult to diagnose this type of condition without direct study, it seems likely that in at least some cases this kind of phrasing is the result of the author's undiagnosed allism. 2.4. general mental impairment ------------------------------ In addition to the specific impairment of introspective senses, an allistic brain is generally less internally interconnected than a normal brain. As a result, an allistic person is less self-aware than someone who is not, and has difficulty controlling and making use of eir brain's full capabilities. Skills such as rapid calculation, accurate and comprehensive memory recall, and some types of precise motor skill, are unavailable to allistic people not because the brain actually lacks these skills, but because the mind is not aware of them. Allistic people are also noted to be easily distracted by novel stimuli. Unlike conditions such as Attention Deficit Hyperactivity Disorder, there is no loss of inherent ability to concentrate on a single task; the problem is simply that attention is easily broken by a new stimulus. 3. living with allism ===================== 3.0. social ritual ------------------ An allistic person learns subconsciously that ey is dependent on others for eir emotional experience. Consequently, ey tends to develop the habit of manipulating the form and content of social interactions in order to elicit from others expressions of emotion that ey will find pleasing when incorporated into eir mind. This phenomenon is manifested as ritual greetings and superficial enquiries concerning irrelevancies. Allistic people often become distressed when such efforts fail by eliciting an unexpected and undesired response. Furthermore, for many sufferers, this emotion-seeking behaviour comes to dominate over normal social interaction, eventually interfering with practical needs. Where allistic people have contact with each other, they tend to subconsciously cater to each other's need for pleasing emotional expressions. Each recognises the other's attempts to elicit pleasing responses, and gives the desired response without any consideration for accuracy, thus avoiding the possibility of an unpleasant experience from an unanticipated accurate response. The effectiveness of the response in affecting the emotional state of the questioner seems to be unaffected by the awareness of both parties of its insincerity. 3.1. issues with text-only communication channels ------------------------------------------------- Notably, some allistic people have some difficulty with channels of communication in which the usual emotional cues are not transmitted, such as email and other text-only media. Often they feel the need to compensate for the missing visual and aural subtext by habitual inclusion of explicit indicators of emotional state, even in messages where their emotional state is irrelevant. Some allistic-designed communication systems, such as LiveJournal, even go to the lengths of formalising the inclusion of emotion tags in each message alongside (but distinct from) the textual content; such emotion tags are often displayed to the user by translation into the visual medium by the use of representative icons. Such systems seem few in number compared to pure text-only communications systems, no doubt because of the allistic difficulty in using and programming computers, discussed in section 3.3. 3.2. problems with truth and falsity ------------------------------------ Allistic people often have difficulty with the difference between truth and falsity. In many circumstances they find it difficult to say accurate things, and will instead say inaccurate things that they find more pleasing. Conversely, on hearing things from others that do not accord with their preexisting notions, they will often seem unable to grasp what has been said: they will often behave as if what was said was what they had previously believed, rather than what was actually said. Conversation with an allistic person can be very frustrating when this happens. This effect causes learning difficulties in allistic people: they have difficulty letting go of simplistic models of the world that need to be replaced with more complex, more accurate, models. This is an easily misunderstood problem. It might appear from the above that allistic people have difficulty distinguishing between the concepts of truth and falsity. On closer examination it seems that most allistic people are actually aware of the difference, but that they don't find it particularly important -- they don't care about factual accuracy. Allistic people have a tendency to judge ideas, and other things, not by their accuracy, or other intrinsic merits, but instead by the style in which they are presented, or by their opinion of the personality of the person presenting them, and other irrelevant matters. 3.3. use of computers --------------------- The allistic difficulty with objective thought processes is particularly problematic when trying to use a computer -- a task that is increasingly important in industrialised society. Allistic modes of thought are largely incompatible with the way computers process information. It is partially this increasingly important incompatibility that has led to identification of the allistic condition. Although recent work in computer interfaces has led to great advances in making computer use accessible to allistic people, the right techniques are not in common use. Most current attempts to cater to allistic computer users amount to restricting the amount of information that the user can manipulate at once, making the shared information space small enough for an allistic person's impaired thought processes to be able to cope with, at least if the user's allism is sufficiently mild. Computer programming still remains essentially closed to the allistic. IT professionals are rarely actually biased against the allistic, and indeed some allistic people have had successful careers in IT, but they are invariably the more mildly afflicted, and they are never among the most skilled or prolific in the field. 3.4. religion and belief ------------------------ Because of the lack of concern for factual accuracy described in section 3.2, allistic people find it uncomfortable to be presented with an accurate idea that, according to the criteria they hold more important, is less valuable than a contradictory inaccurate idea that they previously held. Unsurprisingly, many allistic people turn to organised religion, which provides them with an unchanging set of things to believe and a highly attractive way of presenting and affirming those beliefs. Argument from authority -- which is key to most organised religions -- is a self-affirming and simple way to judge ideas, making it attractive to allistic people. The collective worship of organised religion provides an environment in which not only can the allistic person be sure that eir beliefs will not be challenged, but also ey can expect eir religious beliefs to be affirmed, by the many people present, in a ceremonial manner that ey values highly, and so which serves to further strengthen eir beliefs. Even outside the confines of collective worship, organised religions seek to discourage any challenge to their beliefs that would disturb their allistic believers. Some religions go so far as to explicitly value faith over reason as a means for judging ideas, and make it a religious crime to consider the factual accuracy of the ideas they promote. Judgement of ideas by criteria other than factual accuracy naturally makes it possible to simultaneously value highly two ideas that are factually contradictory. Some allistic people display this ability to hold contradictory beliefs; this is encouraged by religions, which generally care little for the consistency of their doctrine either with itself or with observable facts of the physical world. Of course, when an allistic person claims to believe two mutually exclusive things, they obviously have a strange conception of what belief is -- some type of belief that has no relation to factual accuracy -- and it becomes difficult to say that they are capable of believing anything in any meaningful sense of the word "believe". 4. study of allism ================== 4.0. development of allism -------------------------- Allism is a developmental disorder. Symptoms first appear around the age of two years. By the age of three years it seems to be firmly determined whether a person is allistic or not, and there is little that can be done to affect it after that. Although the physical cause of allism is not perfectly understood, and requires further study, we are reasonably certain of the general mechanism. The initial abnormality in neurological development occurs very early in gestation, in the first month of pregnancy, and further neurological abnormalities occur in parts of the brain that develop later. The abnormalities include a slightly enlarged brain stem, with extreme enlargement of some substructures within the brain stem; other pathological structures develop in the cerebellum and the cerebrum. It appears that the allistic neurological structures become active around the age of two years. When this happens, one of the pathological structures starts to observe information coming from the external senses, and learns to decode emotional signals, such as those in posture and tone of voice. If that were all there were to it, this structure could actually be useful. But the pathological structure gets control over the brain's own emotions, and makes the brain actually experience the emotions that it decodes, rather than merely making the brain consciously aware of what it has decoded. From this point on, normal brain development is overshadowed by the effects of the allistic brain structure. Because the pathological structure so powerfully affects the brain, by directly modifying its emotional state, the developing brain starts to concentrate its efforts around that effect, instead of getting a well-rounded understanding of itself. Much of the mental map that gets developed is concerned with the emotions of others, and emotional content in communication -- things that, due to the anomalous emotion handling, have become extremely important to the brain. Meanwhile, the brain's capability to have and to be aware of its own independent emotional state atrophies. By the time basic mental development is essentially complete, around five years of age, most of the mind that has developed is structured around the allistic effect. Even if the pathological physical structure could be removed or disabled, it is too late to allow development of a normal, non-allistic, mind. Indeed, the developed allistic mind has become in some ways dependent on the allistic effect, and would find its removal most disturbing. 4.1. genetic predisposition --------------------------- There is no doubt that allism is partially hereditary, and there are now some good candidates known for genes that contribute to it. It is not purely genetically caused, however: where it is common in a family it occasionally skips generations, so clearly one can carry a genetic predisposition and pass it on to children without showing any symptoms oneself. It is also possible, and apparently common, to suffer from the condition without having any genetic abnormality. Insufficient study has been done to determine the risks of passing the faulty genes to children when either or both parents have them. This will no doubt improve when the genes are positively identified, and when the link between the genetics and the neurology is better understood. Qualitatively, we know that with one allistic parent there is a greatly increased chance of an allistic child, and with both parents allistic it is almost guaranteed that any child will be affected. 4.2. diagnostic criteria ------------------------ It is too early in the study of allism for precise diagnostic criteria to be agreed. However, the following symptoms are considered relevant. In all cases, symptoms should be visible before age three years. (a) marked reliance on the use of multiple nonverbal behaviours such as eye-to-eye gaze, facial expression, body postures, and gestures to express things that could readily be expressed verbally (b) emotion echolalia (mirroring the emotional expressions of others) (c) in play, a lack of curiosity about the physical properties of objects (d) apparently inflexible adherence to specific nonfunctional social routines or rituals (e) persistent preoccupation with emotionally expressive parts of people, especially faces (f) a tendency to be distracted from one object or activity of interest by the parallel presentation of an alternative stimulus Not all of these symptoms will necessarily be present in any allistic person, and nor will they necessarily all be absent in a non-allistic person. A majority will be present in most allistic people. 5. postscript ============= If you haven't already worked it out: allism is the condition of not being autistic. In current psychiatric practice, it is autism rather than allism that is considered pathological. This article, up to the postscript, has been a parody of conventional psychiatry; the parody would be a serious article in a fictional world where what what we in the real world call autism is considered normal. My reason for writing this parody is not to encourage people to treat allism as pathological, even though that is close to my instinctive viewpoint. Rather, I'd prefer for neither condition to be considered pathological. They are alternative brain structures, both valid, with a continuum of intermediate possibilities, just like heterosexuality and homosexuality. Of course, regardless of what we consider to be "normal", it is appropriate to apply neuropathological investigative techniques to learn more about both conditions and about the relation between them. The word "allism", invented for this article, is intended to precisely complement "autism". It is based on the Greek word "allos", meaning "other", just as "autos" (in "autism") means "self". By giving both conditions labels, we can avoid implicitly marking one condition as abnormal. I'd like "autistic" and "allistic" to have no connotations of normality or abnormality; they should be treated as descriptive terms on a par with "male" and "female". The parody contains no references, because to maintain consistency of the fictional world the referenced articles would have to also be written from the autism-as-normality point of view. The clinical information presented herein comes from conventional articles on autism, translated into the fictional world by reversal of the terminology. Other information comes from personal experience (of the autistic normality) and from discussion with allistic people concerning their condition. The list of diagnostic criteria for allism in section 4.2 is, in part, based on the DSM-IV diagnostic criteria for autism. Allistic people really do seem as bizarre to me as I made them appear above. I hope that some allistic readers, in reading about the autistic introspective senses (which really do exist), may have had a similar reaction to what I had in reading about empathy. Until the age of 22 years I was unaware that empathy existed; I learned about it from a book about autism which had a paragraph describing autistic people's lack of it. It appears that the idea of such powerful introspection is as weird to allistic people as the idea of emotions being contagious is to me. Allism currently occurs in 99.4% to 99.9% of all people in the industrialised world (figures vary wildly between studies). Fortunately this disturbingly high number is falling, and, as it does, general understanding of autism is increasing. Mine may be the last generation in which autistic people routinely reach adulthood undiagnosed. But diagnosis is only the start of the solution: there are thousands of aspects of daily life in industrialised society that are unintentionally tailored to allistic modes of thought and make life difficult for autistic people. As the proportion of autistic people rises, mass institutionalisation is not a viable option. Human society must cease to be purely allistic society; we need to make ordinary human society tractable to autistic people. We need to end this unintentional discrimination against autistic people, by making the general public aware of the issues; we need to have every ordinary person end their own unconscious discrimination.