On the Spectrum

By Alec Pruchnicki, MD

Like many people, my personality has had various eccentricities and changes over the years. From hermit-like shyness at times to excessive verbiage at meetings, I’ve run the gamut. As a child I was always a loner and as an adult I’ve been outspoken and blunt enough to be classified as inconsistent, if not an outright AITA (look it up) jerk. I didn’t think much of these personality traits until I was dating a family therapist who recognized my behavior as similar to what some people with very mild Asperger’s Syndrome exhibit. She wondered if I might even be at the low end of the autism spectrum. What a relief! I wasn’t a jerk but just “on the spectrum.”

I’m not saying this to minimize what people with autism have been diagnosed with, whether the lowest level of neurological or behavioral deficits or the highest level — like what RFK Jr. was describing in a recent public statement. It was just a variation in my personality that I changed when I could and lived with when I couldn’t change. What this was not was proof of an autism epidemic like many anti-vaxxers are claiming recently occurred as the use of vaccines have expanded.

Although I’m not an expert on any type of autism, I know that the medical community believes that these neurological deficits are usually caused by genetic variation. If there is a significant environmental effect, it hasn’t been discovered yet. Did something else in the environment cause my behavior traits? Did something in the environment affect me when I was in my mother’s 33-year-old womb and she was working in garment center sweat shops with who knows what contamination floating around?

What gives rise to the increased numbers of autism cases is widely believed, by the main line medical community, to be from better diagnosis and understanding of symptoms and re-classification of deficits from psychiatric illnesses to neurological illnesses. We have just gotten better at understanding a human condition that has probably been around forever, but never assessed accurately.

This isn’t the first time that organized medicine has improved its understanding of disease and given rise to a false epidemic. During medical school and one of my earliest academic appointments, I was doing basic scientific research on Alzheimer’s disease. There was a great interest in new discoveries and new treatments which has persisted to today, and some media wondered if there was an epidemic of Alzheimer’s disease occurring.

Up until a century ago, it was believed that all people would develop dementia, described as senility or senile dementia, if they lived long enough. In 1901, Alois Alzheimer examined Auguste Deter, a 51-year-old woman who had many of the cognitive deficits seen in so-called senile dementia. When she died, Alzheimer examined her brain pathology and found that there were abnormalities at the cellular level in her brain cells. These were described as plaques and tangles which were usually not seen in normal brains of people with normal cognition. He described this as “pre-senile dementia” and it appeared to be a newly discovered condition.

But, it wasn’t. As more research was done over the decades it was found that older adults who had “normal” dementia actually had the same plaques and tangles seen in Deter, and older adults without dementia had few if any of these plaques and tangles although there are many other diseases that can give dementia in older adults (strokes, Parkinson’s disease, neurosyphilis, etc.). There wasn’t a new epidemic of Alzheimer’s disease, there was just an epidemic of proper diagnosis for something that had mostly always been around.

In both cases, better diagnosis and sophisticated definitions gave rise to apparent epidemics. If I am on the autism spectrum, and someday might be on the dementia spectrum, I hope my evaluation and treatment is done with the most up-to-date medical accuracy possible and not just attributed to imaginary, if not downright conspiratorial, causes. Alois Alzheimer would have wanted it that way.