- A British judge blocked the extradition of Julian Assange to the U.S. because he has autism and thus may be suicidal.
- Diagnosing Assange with autism illustrates why the DSM-5 dropped Asperger Disorder.
- Autism seems a dubious diagnosis, given Assange's extreme cognitive and social competence.
- Even if it's a correct diagnosis, there are many people with autism serving lengthy sentences in both the U.S. and UK.
To be clear: I am not attempting to diagnose Julian Assange, a man I have never met and about whom I do not have any information aside from what has been publicly reported in news articles about his political activities and criminal cases. I am not in a position to answer a question such as “Does Julian Assange have autism?” Although I freely admit that I find the claim (accepted by a British judge as a reason for blocking his extradition to the U.S.) to be debatable. I do know a lot about Autism Spectrum Disorder (ASD) and have given much thought over the years to the limitations of psychiatric classification, especially when applied to neurodevelopmental disorders such as ASD. Thus, the focus of this post has less to do with Assange and more to do with the fuzziness of the autism construct, and the unreliability of its use in diagnostic (especially legal) settings.
The problem with the autism diagnosis, as with some other brain-based disorders, is that there is very wide variability in terms of the severity of the core symptoms, ranging from (the low-functioning end) people who lack oral communication, have severe intellectual deficits, and engage in repetitive self-stimulatory behaviors to, at the other (high-functioning) end, individuals whose communications are correct but odd, have narrow obsessional interests, and have average or above-average intelligence. It was because of this bifurcated nature of the autism population that the sub-type of Asperger disorder was added to the DSM in 1994 to encompass the odd but relatively non-impaired end of the spectrum. By “relatively non-impaired” I am referring to people who can function independently, and do not have a need for developmental services such as residential or vocational supports (although they may have trouble getting or holding jobs that are commensurate with their intelligence, usually because they lack adequate social skills).
In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was released, and the Autism Spectrum Disorder (ASD) sub-category of Asperger Disorder was no longer in it. The reason for dropping Asperger Disorder was due to a feeling among psychiatrists that it was being used inappropriately because of its vagueness, and its substantial overlap with normal nerdiness or shyness. Instead, a single spectrum disorder was created with the idea being that individuals formerly labeled with Asperger would now be handled as follows:
- some would no longer have any psychiatric label at all
- some would be retained under ASD at the high-functioning end
- some would be placed in a newly-formed psychiatric category: Semantic Pragmatic Disorder (SPD; a category that seems not to have caught on yet)
It is my impression that British psychiatrists (who are under no obligation to use the American Psychiatric Association’s DSM manuals) never got the memo about autism being an over-used diagnostic category. Diagnosing Julian Assange with autism seems an example of this, as he is a man with various talents: an extraordinary computer hacker, but also someone with the social competence to organize a large social network of friends who share his political views. Certainly, he is someone capable of functioning in the world independently, as was the case before he was threatened with arrest (and before anyone thought to diagnose him with autism).
The judge who granted Assange’s petition to avoid extradition to the U.S. was persuaded that Assange would be a suicide risk if incarcerated in the U.S., because:
- he was persuaded that the American prison system would treat Assange harshly
- he was shown research suggesting an increased incidence of suicide among autistics (whose depression reflects a failure in social roles and social acceptance).
I have no reason to doubt that Assange (serving a prison sentence in the UK for violating his bail conditions) is depressed, nor that he has expressed an intention to kill himself if he has to face charges in an American court. But using Assange’s alleged autism disorder as an excuse seems a stretch, both because
- there is little likelihood that autism is an appropriate diagnosis for him
- people with autism commit crimes and go to jail (sometimes for very long sentences) and I have never before heard that autism provides an automatic “get out of jail free” card, either in Britain or the U.S.
Copyright Stephen Greenspan