AN EMOTION-BASED SPECTRUM OF MENTAL ILLNESS

Without theory there are no questions;
without questions, no learning;
hence, without theory there is no learning.
--W. Edwards Deming

Once again, please note that the words

• communicator
• noncommunicator
• communicative
• noncommunicative

are technical terms which refer to deep emotion and deep emotion only. Obviously, noncommunicators often show great skill with communication channels other than the deep-feeling communication channel.

Continual clinical observation supports four related findings about the nature of emotional experience. The four findings generate a useful approach to rigid ways of acting, thinking and feeling which otherwise resist cognitive and behavioral interventions.

• 1. A crucial and far-reaching division separates all feeling into two types: surface and deep. The experience of surface feelings, like anger and guilt, preserves emotional rigidity. Conversely, the experience of deep feelings, like grief and loneliness, promotes health. It follows that a helper with deep feelings must keep persons acknowledging their deep feelings.
• 2. There exist great numbers of people (that is, noncommunicators) who have never contacted an adult human being by means of deep emotion. This lifelong failure to share deep emotion signifies a pervasive and primordial arrest of emotional development in those people who currently lack this highly specific communication of deep emotion with any adult and who historically lacked it with their parenting figure or primary love object. Please note that an individual's status as a noncommunicator never implies psychopathology in that individual.
• 3. The deficit of interpersonal communication with deep emotion and the resulting developmental arrest in early infancy generate a very stable emotional configuration which, in most cases, persists unaltered throughout the person's lifetime. Furthermore, this emotional configuration (that is, the noncommunicative state) not only underlies a high percentage of moderate psychopathologies, like substance abuse and the borderline states, but also underlies almost all severe psychopathologies, like Asperger's disorder, autism, bipolar disorder, dementia and the schizophrenias. Please note two important points:
  • a. An individual's status as a noncommunicator never implies psychopathology in that individual.
  • b. But serious psychopathology in an individual almost always implies noncommunicative status in that individual.
• 4. A helper with deep feelings can remedy the emotional deficit of persons by contacting their deep feelings with his or her own deep feelings. This deep-feeling contact involves no bodily touching between the helper and other persons. Correcting the emotional deficit liberates people from their arrested and infantile deep-feeling configuration. Their formerly arrested emotional structure undergoes rapid development, cognitive and behavioral interventions produce quick results and health replaces recalcitrant, rigid ways of acting, thinking and feeling.

Epidemiology of the Noncommunicative State and Mental Illness

The overwhelming majority of mentally ill people are noncommunicators. And the overwhelming majority of noncommunicators have no diagnosable mental illness.

This last statement is very important so let me go over it again. Virtually every client I ever met in a mental health setting was a noncommunicator. Outside of mental health settings, virtually every noncommuicator I ever met had no apparent psychiatric illness.

Consequently, the relationship between the noncommunicative state and mental illness resembles the relationship between the poliomyelitis virus and paralysis. During the polio epidemics, most people caught the virus and suffered either no ill effects or nothing more than temporary flu-like symptoms. Of the people exposed to the virus, some susceptible individuals suffered transient paralysis. But only rare and particularly susceptible individuals suffered severe and persistent paralysis.

Similarly, upwards of 80 percent of the population are noncommunicators. Of these noncommunicative people, most are normal psychiatrically. (This implies that the noncommunicative state is "normal" for mankind.)

However, some susceptible noncommunicators suffer less severe mental illnesses like alcoholism and character disorders. And only rare and particularly susceptible noncommunicators suffer severe and persistent mental illnesses like autism and schizophrenia.

A Deep-Feeling Theory of Autism

The concepts of deep emotion, communicators, noncommunicators and emotional contact allow me to build a theory of autism. Be warned that the theory integrates a lot of personal experiences, intuitions and guesses. It has four advantages and one drawback. The four advantages are:

• 1. It is simple (parsimonious).
• 2. It connects various forms of autism with one another and with adult psychiatric disorders.
• 3. It offers diagnostic criteria that can be applied starting at birth.
• 4. It offers a treatment that can be administered starting at birth.

Of course, its one drawback is a big one:

• No one has proved it (yet).

The Nature of Autism

Verbal autistics are people who cannot see the forest for the trees. It is important to note that autistics can see the trees. Their problem appears at the next level of abstraction--the meaning or connectedness of all those trees.

Kanner (1943, p 246) pointed out that autistics have "[t]he inability to experience wholes without full attention to the constituent parts . . . ." As a rule then, autistics get the parts and miss the whole. They get the narrow content but miss the wider context.

Stehli (1991) described her autistic daughter prior to auditory training in this way:

Jokes, nuances, double meanings, hints, hunches, inferences, verbal subtleties of any variety were lost on her. I always had to edit my speech: our communication was like primary colors, simplified, and without shades.

Once again we have content without much context.

In other words, autistics lack some of "the thousands of associative threads which guide our thinking." I have quoted Bleuler ([1911] 1951, p 14) who was talking about how schizophrenia interrupts those threads. Autism differs from schizophrenia because, in autism, many associative threads never formed to begin with.

A Leap of Theory

I propose that feelings, specifically the deep feelings, ARE the associative threads that interconnect and guide perceptions, intentions and behaviors. Deep feelings differentiate, modulate, articulate and integrate here-and-now experience and connect it with past experiences. In other words, deep feelings form the context to which immediate content belongs. And the degree of deep-feeling development determines the degree of perceptual-conative-behavioral coherence, that is, wholeness or health. Because deep-feeling development ceased so early in autism, people with autism show a great many perceptual, conative and behavioral disjunctions in their lives.

A complication arises because, by expending monumental amounts of time and effort, autistics can learn coherence in their lives. But the nature of their coherence is cognitive rather than emotional, calculated rather than spontaneous, contrived rather than intuitive. So their coherence resembles speech by the deaf--an astounding achievement but still not beautiful.

Neurophysiologically I am saying that autistics can substitute cortical function for arrested limbic-cerebellar function. Further, I say that deep-feeling contact and subsequent deep-feeling acknowledgment develop limbic-cerebellar function which then supplants its cognitive counterfeits.

The Range of Autism and Beyond

Two events determine the range of autism, a deficit and an arrest. The deficit occurs when the newborn fails to become a communicator during the first six weeks of extrauterine life. No pathology exists as yet because most noncommunicators turn out to be perfectly normal people. But the noncommunicative newborn faces a serious problem: how to deal with intense deep feeling with no deep-feeling communication channel linking the newborn to a parenting person.

Let's define soothing as the reduction of deep-feeling intensity. For the noncommunicative newborn, soothing comes about in two ways:

• 1. Social soothing by means of ordinary parenting activities like bathing, changing, conveying feelings, cuddling, dressing, eye-contact, feeding, holding, kissing, playing, rocking, singing, stroking, swinging, talking and so on.
• 2. Self-soothing in which the newborn soothes deep emotion in ways he or she discovers by himself or herself.

For a newborn, virtually anything can evoke intense deep feeling. The source might be physical like an ear infection, psychological like moving to a new home, or social like the loss (or addition) of a family member. Adults may be unable to discern the source of the newborn's intense deep feeling because deep-feeling responses depend on the particular sensitivities and reactivities of each individual newborn. And we must consider that birth itself probably generates intense deep feelings.

From the standpoint of deep emotion, two sorts of newborns develop autism:

• the very bright
• the persistently distressed

Of course, a newborn could belong to both groups.

Rimland (1964 p 124) proposed that "autism is high intelligence gone awry at its outset. . . ." High intelligence requires an uncommonly adaptive nervous system. Faced with the problem of soothing their deep emotion by themselves, what do highly intelligent newborns do with their uncommonly adaptive nervous systems? They use them to solve the problem to their own detriment by engaging pre-social cognition, which will be defined shortly. And pre-social cognition generates both the wonders and the horrors of autism.

Given time and persistent distress, less intelligent newborns will eventually discover self-soothing on their own. In addition, neurophysiology helps the distressed infant because some soothing mechanisms, like twirling oneself or objects, seem "hard-wired" into human brain structure. When, by chance, a distressed infant hits upon one of these "hard-wired" mechanisms, it gives him or her a great measure of respite from distress.

Let me make a critical distinction. Social cognition (that is, ordinary thinking) starts about age two and is linguistic, that is, strongly connected with human language. On the other hand, pre-social cognition (that is, pre-verbal thinking), if it appears, starts some time before age two and is infantile, that is, largely independent of human language. Whether pre-social or social, all cognition is a cortical function which, in noncommunicators, arrests the development of deep emotion, which is a limbic-cerebellar function. The limbic system mediates emotion and memory. The cerebellar system coordinates various brain functions so the cerebellum is neither an input nor an output organ (that is, neither afferent nor efferent) but an organ of integration or coherence.

The arrest of deep-feeling development has three aspects:

• 1. The complexity, depth and scope of the individual's deep feeling cease to mature.
• 2. The individual's inherent sensitivity to social context stops growing.
• 3. The individual's receptivity to social soothing no longer increases.

Back to the noncommunicative newborn who must soothe his or her intense deep emotion, which may have arisen from the birth experience. From the parents' viewpoint, social soothing is immensely preferable to self-soothing for several reasons.

First, self-soothing requires pre-social cognition which is likely to utilize mechanisms that lie far beyond the pale of anyone's understanding. Consequently, the newborn's soothing mechanism can never be shared. Second, cognition arrests deep-feeling development. What's wrong with arresting deep-feeling development? Deep-feeling development gives the individual increasing sensitivity to social context and increasing receptivity to social soothing.

As a starting point, let us examine a hypothetical newborn named Alfie who is dealing with his own birth trauma. Alfie is a noncommunicator. Before anyone can begin to soothe him socially, he "goes cortical," engages his pre-social cognition and soothes himself by powerful mechanisms which are so distant from our shared social knowledge that we will never understand them. Alfie is placid and easy to raise. His deep-feeling development is zero; he doesn't seem to have emotions. His pre-social cognition reigns supreme, virtually unchallenged by deep emotion. So Alfie's pre-social cognition readily gives way to social cognition at age two. Consequently, he develops adult language normally and, in later life, has no significant emotional experiences. But his sensitivity to social context is also zero and he becomes a peculiar and emotionally detached individual. Alfie represents Asperger's Disorder.

Next, let us examine two hypothetical babies, a girl and a boy named Brava and Chuck, born on the same date into two separate families. Both are noncommunicators. Both babies respond reasonably well to social soothing of their deep emotions until age four months when both suffer a crisis that evokes intense deep emotions. At this point, both "go cortical" and engage their pre-social cognition in order to soothe themselves. Consequently, their emotional development arrests at four months. But the mechanisms they choose for soothing themselves will be both less exotic and less effective than the mechanism chosen by our first hypothetical child, Alfie. Still, we will never share and probably never understand those mechanisms because they belong to a kind of cognition (pre-social) that is both far-removed from and more magically potent than our adult, social cognition.

All goes well until 18 months after Brava and Chuck were born. Both babies have been getting their deep feelings soothed by a combination of weak social soothing and strong self-soothing. Brava's and Chuck's emotional development remains arrested at four months. However, their sensitivity to social context, also fixed at four months but acting in concert with their pre-social cognition, is not too different from the social sensitivity of normal 18-month-olds.

Now the little girl suffers another severe emotional crisis. She abandons social soothing, engages her pre-social cognition full time and withdraws into an autistic shell, maybe forever. Any ordinary language she had disappears. She may never speak again. Brava represents early-onset Autistic Disorder.

Chuck never suffers another severe emotional crisis. But he has to use his pre-social cognition regularly in order to soothe himself. When he gets to age two, his pre-social cognition struggles daily with deep feelings and resists the development of social cognition. The failure of social cognition gets noticed because the development of Chuck's ordinary language is delayed. Chuck represents late-onset Autistic Disorder.

Our fourth hypothetical child is a girl, Deltette. Deltette is also a noncommunicator. But Deltette responds well to social soothing until eight months of age when she suffers a severe emotional crisis. At that point, Deltette "goes cortical" in order to soothe herself. She activates pre-social cognition and arrests her deep-feeling development. But her pre-social cognition is less exotic and effective than Brava's and Chuck's and it is much less exotic and effective than Alfie's. On the other hand, Deltette's sensitivity to social context is much better than the other children's because her deep feelings had more time to develop. Pre-social cognition and eight-month-old social soothing combine and keep Deltette out of serious trouble. Her development of ordinary language may be delayed, but nowhere near as much as Chuck's. And she will probably attain adulthood without attracting clinical attention. If someone tries to diagnose her, she will probably be labeled as one of the many cognitive personality disorders: alexithymic, "as-if," attachment-deficient, schizoid, schizotypal, anorexic, avoidant, dissociative, Tourette's or paranoid. Deltette represents the borderland where Autistic Disorder and other psychiatric conditions overlap.

Pre-social cognition's power to soothe deep emotions declines steadily according to the time it is first established. At birth, pre-social cognition, if engaged, is overwhelmingly powerful. That power declines steadily. So first engaging it at 12 months of age yields a fairly weak soothing mechanism. On the other hand, social soothing really gains strength at about 13 or 14 months. So there exists a very vulnerable period, right around 12 months of age, when "going cortical" and the arrest of deep-feeling development produce a precarious alliance of weak self-soothing and weak social soothing which together act as a time bomb set to go off at pubescence or age 20. At these two times of emotional turmoil, an excess of deep emotion overwhelms the alliance and classical schizophrenia ensues.

From these hypothetical examples, it follows that Asperger's Disorder represents the worst form of autism from the perspective of deep emotion. Of course, Asperger's Disorder is nowhere near the worst form of autism from the perspective of social functioning.

Psychiatry relates the severity of psychopathology with social impairment in a linear fashion, the greater the pathology the greater the impairment and vice versa. But I arrange psychopathology differently, according to the client's incapacity to handle deep emotion in a free and fluid manner. My arrangement of psychopathology, from most severe to least severe, looks like this:

• Asperger's Disorder
• high-functioning autism
• ordinary autism (if the person makes it through childhood)
• cognitive personality disorders
• paranoid schizophrenia
• ordinary schizophrenia
• schizoaffective disorder
• bipolar disorder
• "borderline" personalities
• emotionally turbulent personality disorders
• "depressive" personalities
• neurosis
• normalcy

Across this spectrum, the curve of social functioning is V-shaped. It starts out high with Asperger's, drops to its lowest point with ordinary schizophrenia and then rises again to its highest point with normalcy.

Pre-Social Cognition

Pre-social cognition (described above) is amazing stuff, especially when it gives rise to savant phenomena like extraordinary arithmetic, artistic, mnemonic (memory) and musical skills. (Interestingly, pre-social cognitive skills are usually seen as eerie and preternatural rather than attractive and creative.) And pre-social cognition is quite striking in the extreme ways that it organizes sensory input. It can see the tiniest detail and be blind to looming dangers. It can hear the faintest sound and be deaf to the loudest call. It can feel the least touch and ignore a deep wound. It can reject the slightest variation in taste and consume the most bitter poison. It can detect a wisp of odor and never notice the worst stench. It can balance like a tight-rope walker and stagger like a drunk. It can be upset by a minute rise in temperature and be oblivious to freezing conditions. It can be bothered by the vibration from a passing automobile and be indifferent to a medium-sized earthquake.

In terms of spoken words, pre-social cognition is likewise amazing. It can repeat whole sequences of words with exact accents and intonations (echolalia). It can sometimes read complex passages accurately (hyperlexia). It can use gestures and name things. Sometimes, these verbal features of pre-social cognition obscure the fact that ordinary language is failing to develop in the autistic child.

But pre-social cognition is woefully inept at other language acts. It cannot handle abstractions like pragmatics, pronouns and prosody. It cannot give meaning to stories. It cannot carry on a truly reciprocal conversation. And it cannot achieve emotional expression except for anger and maybe some of the other surface feelings like anxiety.

The delay, abnormality, regression or lack of language clearly indicates autism. But I, along with many parents, cannot wait two or three precious years before we attempt to detect autism in an infant. We need diagnostic criteria that we can apply immediately, even to a newborn. Too many children, often our brightest and best children, have been lost to autism while parents waited in the vain hope that, "He (or she) will grow out of it."

The Early Diagnosis of Troubled Noncommunicators

Parents can apply nine deep-feeling diagnostic criteria that suggest autism. They can apply these criteria to any child starting at birth.

• 1. Does the child have sleep disturbances?
• 2. Is the child's eye contact poor?
• 3. Is the child's body language unaccommodating like becoming stiff, going limp, failing to anticipate being picked up or failing to mold to the parent's body?
• 4. Does the child lack deep emotions?
• 5. Is the child's deep emotion static or monotonous, with only one or two emotions evident, for example, terror or horror?
• 6. Is the child either inconsolable or in need of constant consolation with respect to deep emotion?
• 7. How does the child handle naturally occurring episodes of deep emotion?
• 8. What happens when you induce deep emotion in the child with close physical contact?
• 9. What happens when you induce deep emotion in the child with the direct expression of your own deep emotion to the child?

In a moment, I will discuss these criteria in more detail. But first, I must discuss a special reason for early diagnosis besides the obvious one of saving the child from autism.

These deep-feeling criteria cast a large, fine-meshed net which will "catch" a great many disturbed and disturbing infants, some of whom are not truly autistic. I hope that the criteria will "catch" every potentially autistic child. I have no wish to widen the diagnosis of autism to include all these upset infants. But an infant's problems with deep emotion often rob him or her of vibrancy. And parents, who have taken on the responsibilities of bringing new life into the world, have some right to the enjoyment which a vibrant infant brings them.

Beyond Vibrancy

Deep-feeling communication with an infant exhilarates the parent beyond description. It is as if this small person understands every nuance of the parent's deep emotions. Compared to the exhilaration from such profound understanding, the euphoria of recreational drugs shrivels to almost nothing. I have no idea if this exhilaration can occur with every infant but I want the reader to know that it exists as a possibility. I do know that the exhilaration fades as the infant grows and becomes more autonomous. And the exhilaration of deep-feeling communication is gone by the time the child is two years old.

Deep-Feeling Criteria that May Diagnose Autism Early

The first criterion

• 1. sleep disturbance

is, in my experience, the earliest sign of any mental disturbance associated with deep emotion.

The next four criteria

• 2. poor eye contact
• 3. unaccommodating body language
• 4. absent or flat deep feeling
• 5. static or monotonous deep feeling

are largely self-explanatory.

The sixth criterion

• 6. inconsolable deep feeling or the need for constant consolation of deep feeling

may be a good sign. The newborn may have, as yet, failed to soothe his or her own deep feelings. More likely, he or she has made a parent an indispensable part of the pre-social cognitive scheme he or she is using to soothe himself or herself. It is highly unlikely that anyone will ever understand how this scheme utilizes the parent.

The seventh criterion

• 7. the infant's handling of deep feeling in day-to-day living

is perhaps the most important one. Here the parents' formulation carries great weight because they spend so much time with the infant in familiar settings. Does the child convey deep feelings when upset? Or does the child "disappear" emotionally into a trance or a rage until he or she has succeeded at self-soothing?

Be wary of smiling and crying. Smiling often accompanies surface emotion. Accept your child's smile but do nothing to augment or sustain it. Watch the smile to see if it fades and reveals some deep emotion underneath it. Crying may be tears of rage, which is a surface emotion that cloaks deep emotion. Meet crying with neutral attention and minimal soothing until you can see what it's about. Tears of rage tend to be steady and prolonged. Tears of pain (or other deep emotions) tend to be wave-like and short-lived. It may be hard to distinguish the tears of surface emotion from those of deep emotion.

The last two criteria address deep emotion which is deliberately evoked in the child

• 8. by close physical contact and
• 9. by the direct expression of your own deep emotion to the child.

Both of these criteria depend on the fact that deep emotion is contagious. That is, the deep emotion of one person automatically evokes the most available deep emotion of anyone else who is present. I say "the most available" deep emotion to emphasize that the deep emotion of the other person need neither match nor be compatible with the first person's deep emotion.

The direct expression of deep emotion is quite difficult for people who are unaccustomed to handling deep emotion. I mention the technique here in order to complete the diagnostic list and in order to alert parents to an action which a helper with deep feelings might perform with them and their child.

	Contacting Jason
	Cognitive Personality Disorder

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