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Sunday 7 July 2013


Imagine how outraged parents of children with autism would be if this was published today.

"The role of affect in the pathogenesis, maintenance, and relapse of autism is unequivocal. “Emotional disturbances” (citation from 1970's) have long been recognized as underlying these disorders, and affect has been implicated in triggering autism (citation from 1982). Social interaction problems and difficulties with verbal and non-verbal communication is understood as the displacement of negative affect. Refusal to show more than a limited interest in activities and play can then be understood as an attempt to render feelings amenable to control and change (citation from 1997). These individuals present with significant impairment in affective functioning. Alexithymia, or the inability to identify and label accurately affective experience, and emotion-processing deficits, characterize the population (citation 1995). A central function of autism can be understood as an attempt to control affect (citations from 2000 and 1998).

In the emotion-focused theory of development, emotions and the manner in which the self organizes to handle them play a central role in the development and organization of the healthy self, and in the development of psychopathology. The theory postulates the development, primarily in the formative years, of implicit emotional meaning structures (citation). The individual is born with an innate capacity for emotional response and experience, and in early interactions these evolve into core emotion schemes. Innate, healthy, adaptive emotions such as fear in response to threat, anger at violation, and sadness at loss, provide crucial information to the individual both in regard to internal experience as well as surroundings. In healthy development, caregivers’ responses to these emotional reactions in the developing child validate the emotion and provide coaching both in paying heed to and in handling the array of emotions the individual will experience. Such accurate “processing” of emotions promotes efficacy and resiliency in dealing with future reactions. The individual learns to flee danger, set boundaries, self-soothe, and seek solace in the presence of the soothing other, as appropriate.

If, however, early experience of emotion is met with less optimal, or problematic, responses from caregivers, this will result in the development of core maladaptive emotion schemes, in contrast to healthy and resilient ones. The developing self will organize to cope, both with the difficult emotion itself and with the inadequacy of the caregiver. A family rule that one must not show anger may result in a core maladaptive emotion scheme by which healthy anger is suppressed. Shaming in response to tears or to reaching out for affection may result in core maladaptive shame, and in a maladaptive emotion scheme by which the individual suppress- es the healthy expression of sadness or the spontaneous yearning for communion with another. The self thus organizes around emotional experience to form core maladaptive emotion schemes that function to manage the difficult feelings. Over time, however, the core maladaptive emotion scheme results in increasing difficulties as the individual attempts to navigate emotionally evocative events including developmental challenges such as reaching adoles- cence, changing schools, or moving house; personal injury such as the loss of a loved one; or trauma such as a sexual assault. The core maladaptive schemes become increasingly inadequate to manage the feelings evoked, and the maladaptive emotions become more difficult to tolerate. 

A number of factors make autism in particular a compelling solution to this problem of needing to manage unwanted negative affect. Lack of interoceptive awareness associated with a confusion of internal states of emotion (citation) can create a predisposition for autistic behaviours. The autism provides a set of strategies that reinforce an alexithymic style (citation), preserving an unflawed image of perfection by not expressing negative emotions (citation). Overall, the non-communication becomes a highly effective site for affect management and control (citation). "

All I have done is alter eating disorders to autism and body image symptoms to those symptoms of autism.  The world would be up in arms and condemnation from all sorts of international bodies would be flying left, right and centre.

So why are clinicians still allowed to write this kind of crap today about parents of children with eating disorders?

Shame on you:

Joanne Dolhanty, Ph.D., Leslie S. Greenberg, Ph.D.
Sadly, both clinicians claim that they "do not blame parents", whilst lecturing and selling their "therapy" across the world.  Yeah, right.  And I am President Obama in disguise.


  1. Thank you Charlotte for highlighting this enduring practice. When I tell practitioners who are well versed in the brain science that I am seeing and hearing other practitioners such as these two still spreading this 'crap' as you so aptly coined it, they are surprised. They will say to me that they think it is very rare now days to find a professional who still espouses these outdated and unscientific beliefs.

    I have a theory - and it is simply a theory, not tested by any science that perhaps people see what is around them and that becomes our reality. It appears to me that this is happening at both ends here. For those who still are espousing this 'crap' it is their reality (and not enough brave souls are calling them out on it like you are Charlotte) and for those who think this 'crap' thinking is all in the past, they only see colleagues around them who have kept up with the scientific research.

    That is a bit of a diversion from your focus here but my reason for sharing it is that for many parents/families who are exposed to 'crappy' thinking practitioners, when we do find those who are up to date we come with a lot of trepidation and mistrust. And when these up to date practitioners see us they are not understanding that what we've experienced is treatment failure and we're not too likely to have blind faith in what they tell us to do. We can also look a bit controlling at that juncture and color their perceptions of us.

    Thank you for this very enlightening expose Charlotte. This way of thinking is still very prevalent and only by speaking out as you are doing will we change this. The world is not flat - what a radical concept.

    Becky Henry

  2. I agree with Becky: the persistence of these concepts AND the "shock, shock" that it still goes on are rooted in the same problems. Not to mention the result of having parents greet even the best folks with a weary eye.

    The antidote is accountability and the sunshine that we create when we speak up, as you are, Charlotte.