Please Stand By is a Quietly Subversive Film

Maxfield Sparrow
unstrangemind.com

Me too. Which is why I can't wait until Hollywood starts getting that stuff right so I *can* just relax and enjoy a film about people like me. #PleaseStandBy

— Unstrange Mind 🖖🏼 (@UnstrangeMind) January 28, 2018

[image: Twitter exchange: “I want to see Please Stand By but as one on the spectrum I don’t want to be hung up on the attention to detail and accuracy of the portrayal at the expense of actually enjoying the movie.” -@GlennHampson

“Me too. Which is why I can’t wait until Hollywood starts getting that stuff right so I *can* just relax 

and enjoy a film about people like me.” - @UnstrangeMind]

That Twitter exchange sums up how I feel when I watch fictional movies that feature Autistic characters, like the recent release Please Stand By. I want to just sit back and let the experience carry me away to fantasy land like I do with nearly every other movie I watch ... but I can’t.

WWII historians cannot passively watch Enemy at the Gates or U-571, and enjoy them as thrilling drama without picking apart all the inaccuracies. Alan Moore fans cringe while watching film versions of his graphic novels that changed his work so much Moore demanded to have his name removed from the credits.

Likewise, it is impossible for me to just relax and watch Autistic fiction created by non-autistic writers, directors and actors because I cannot turn off the internal critic that sees every misrepresentation and misunderstanding of my people, writ large upon the screen. As a result, I watch autism stories in movies and on TV in three layers simultaneously: political, representational, and artistic.

In the political channel of my mind, I am examining whether the writer, director, actors, and consultants were actually Autistic or not. I am looking at how the storytelling choices of the creative team might increase, or decrease, the stigma we Autistic people live with.

The representational channel of my mind is exploring how well Autistic people were depicted, regardless of who was creating the story I’m watching. Of course it will be easier for actually Autistic people to create a story that represents us well, but I do believe non-autistic people can do a good job if they pay attention to Autistic voices and work carefully.

The artistic channel of my mind is that part of me that would have just been sitting back and enjoying the ride if I were watching almost any other movie. When I can easily suspend my disbelief, and just enjoy a movie as a work of art and entertainment without interference from the political and representational channels of my mind, this channel carries my entire impression of a film.

So this review of Please Stand By reflects the way my mind splits into those three channels when I watch autism fiction. I’d like to start with the artistic channel because it’s the simplest to talk about: Please Stand By was cute and fun. It was a little less about Star Trek than the trailer suggests, but there was still a lot of Star Trek content, including that iconic moment when Patton Oswalt’s character has a short conversation in the Klingon language with Dakota Fanning’s character. I warn you, though, that the fanfic moments in the film comprise less than a quarter of the overall movie. If your only reason for watching it is because you are a Star Trek fan, you will find it a quirky curiosity only worth adding to your collection for the sake of completion.

Please Stand By had funny moments, sweet moments, I-really-hate-that-character moments, and a couple of touching moments. Stripped of political and representational significance, I see it as a fun, lighthearted “date movie.” But viewed through my two other lenses, Please Stand By is much more than twee, feel-good entertainment.

The movie is about Wendy, a 21-year-old Autistic woman who lives in an unbelievably spacious and well-appointed group home with the euphemistic name of the Bay Area Assisted Living Center. Wendy loves knitting, her little dog Petey, and Star Trek. The movie opens near the end of Wendy’s intense focus on writing a Star Trek script for a Paramount contest, so Wendy’s passionate interest in Star Trek is on high during the eventful few days of her life depicted on screen.

I watched Please Stand By three times through, as well as re-watching a few select scenes. While immersed in the movie, I found my opinion of it shifting with each viewing. My thoughts and opinions about the movie continued to percolate and evolve even after I finished watching, as I played through the movie’s messages in my mind. As a result of such careful scrutiny and digestion, I have come away with the opinion that Please Stand By is a positively subversive film that will help reduce the stigma Autistic people live with, through its subtle storytelling.

The film clearly demonstrates the dehumanizing injustices Wendy faces every day without being “in your face” about the fact that they are injustices, or dehumanizing. Unlike many films and TV shows that try to spoon-feed Important Messages and Information to the viewer, Please Stand By artfully arranges realistic situations, then leaves the viewer to connect the dots herself. While Wendy lives in a comfortable home with Scottie, a support worker who speaks to her in a gentle voice and helps soothe Wendy through a meltdown with her calming phrase, “Please stand by; Please stand by,” Wendy is simultaneously subjected to the world’s consensus opinion of her incompetence, and repeated discussions of what a burden she is.

Scottie takes good care of Wendy’s physical needs and helps Wendy structure and organize her life, but also insists on frustrating and painful training in things like sustaining eye contact or something called “names and places” that neither Wendy nor Scottie enjoy but “has to be done” because it’s one of the mandated things that Autistic clients must study.

And while it’s clear that Scottie cares about Wendy, she is also seriously failing as support staff because she knows next to nothing about Star Trek, Wendy’s greatest passion in life. Scottie makes sure Wendy gets undisturbed writing time, and has taken care to add a daily Star Trek episode to Wendy’s schedule—but Scottie doesn’t even know what a Tribble is, and can’t keep Star Trek and Star Wars separate in her mind. Scottie is working to bring Wendy into alignment with Scottie’s understanding of the world, but has not done nearly enough to enter the world that is most important to Wendy.

And Wendy trusts Scottie, but resents the life that has been shaped for her. Wendy wants to meet her infant niece, Ruby. She wants to return to the house she grew up in. She wants to set her own schedule, and not have to battle her home's four other residents for access to shared resources. Wendy wants to live her own life with her own choices in her own space. It doesn’t seem too much to ask. But while Wendy is portrayed as having “made a lot of progress,” she is not even permitted to cross Market Street by herself, let alone be trusted to be safe around infants like her niece, or responsible enough for supported independent living and making her own decisions about the course of her life.

Early in the film we witness Wendy having a meltdown. It was hard for me to watch. It was fairly realistic, and one thing it showed was that Wendy is not violent. Yes, her sister Audrey got hit in the face—but it was because Wendy was hitting herself in the head and Scottie slipped while trying to restrain Wendy, causing her hand to fly into the sister’s face. Audrey had been closing in to help with the meltdown, despite being the source of Wendy’s distress as well as seeming to know even less about how to help Wendy than Scottie did. (Scottie did help Wendy to calm down, but I was disturbed to see her continuing to restrain Wendy long after she had stopped hitting herself.)

The meltdown served another purpose, further contributing to Please Stand By being a subversive film. Not only did it show that Wendy would only harm another person through someone else’s accident, not her own choice—but it showed Wendy melting down over matters that just about anyone would recognize as huge, valid, serious issues. So many movies depict us Autistics melting down over things that are serious to us, but intentionally chosen as issues that seem trivial and pointless to many non-autistic people. But Wendy was upset about huge, valid, serious issues for anybody experiencing them: having her home taken from her, at having no choice about how she gets to live her life, and about not being allowed to meet a new family member she clearly adores. While someone not used to thinking about autism issues might overlook this incident on a conscious level, Wendy’s meltdown was understandable.

On the one hand, it stings that our trauma is only viewed as legitimate when it lines up with neurotypical ideas of trauma, but from a political perspective it is so important and validating that Please Stand By chose a meltdown scenario that pretty much any viewer is going to take seriously. Helping the viewer to take Wendy seriously is subversive.

Another subversive element of Wendy’s character is how sweet, gentle, harmless, whimsical, and delicate she seems. She was clearly written and cast for the audience to love. Even more important than her adorably quirky appearance is her stainless steel personal strength. There are so few representations of Autistic women to start with. I am grateful that the playwright who began this story started with his one-act play chose to portray an Autistic woman with such  power and persistence. While there are aspects of Fanning’s performance as Wendy that feel a bit strained, overall her representation of feminine autism is positive and valuable.

Wendy’s character was intended to be a woman from the very first moment she emerged as a story seed in writer Michael Golamco’s mind. In a recent interview, the author notes that the kernel of inspiration for the story came from a 2007 New York Times Magazine article about Autistic women. Golamco pulled together what he learned from that article and his own love of Star Trek and life as a writer. While probably not intentional, the heavy emphasis on Star Trek in the storyline is another subversive element, just like Wendy’s charismatic presence and the large number of established celebrities in the cast. Many people who would not necessarily have chosen to watch a movie about autism will be drawn to Please Stand By because of the Star Trek content. These people will enter the theater to hear Klingon dialogue and leave the theater with a fresh view of the power of following a passionate dream and new respect for the, perhaps unexpected, competence an Autistic person can display, even while being dismissed by others.

One of the most common complaints about representation is how often Autistic people are portrayed by non-autistic actors. In fact, other than documentary films, I can only think of one Autistic character portrayed by an Autistic actor: Christopher Boone, in the play based on the novel, The Curious Incident of the Dog in the Night-time, who has been portrayed by Mickey Rowe. I can only think of three other famous Autistic actors—Dan Aykroyd, Darryl Hannah, and Anthony Hopkins—and none has yet portrayed an identified Autistic character. (Although, in fairness, Wendy is not officially identified as Autistic, either. It is quite clear that she is Autistic and Golamco says that he wrote her as Autistic, but the word “autism” appears nowhere in Please Stand By, for whatever reason.)

While Please Stand By did not cast an Autistic person in the role of Wendy, it is politically important that there are four Autistic actors in the film. These actors appear in the credits, and if Please Stand By is covered by SAG-AFTRA (I’m not sure whether it is or not) that makes those actors eligible for their Screen Actors Guild cards, which opens many doors in the world of acting. Additionally, their professional work helps others in Hollywood to recognize that hiring actually Autistic actors is a possibility, and the work of those actors—Lexi Aaron, Dominique “Big D” Brown, Brittanie Sanders, and Cindy Miyashiro—could help to open the door for more Autistic actors in the future.

A California organization called The Miracle Project, also the group behind the documentary Autism:The Musical, helped these four Autistic actors. The Miracle Project supports Autistic actors with classes, performances, and more. While the four Autistic actors in Please Stand By only had small roles, they are helping to move Hollywood into the 21st century with respect to the importance and value of Autistic actors in the entertainment industry. The Ruderman Family Foundation reports that while 20% of the population is Disabled, only 2% of television characters have a disability. Moreover, 95% of those characters are portrayed by non-disabled actors. The situation in Hollywood is similar.

We’ve got a long way to go with the politics and representation of Autistic people in movies and television, but watching Please Stand By I couldn’t help notice how far we’ve come since the days of Rain Man. The film is operating on multiple levels and the fact that it manages to come across as “fluffy and fun,” while carrying some very serious messages to viewers, benefits Disability representation in proving that a movie can address serious issues while maintaining general appeal.

One example of the multiple levels the movie is operating on is that Scottie seems kind, caring, and supportive but the viewer gradually realizes she is part of an entire system holding Wendy back from becoming everything she could be. When Wendy breaks the rules and crosses Market Street for the first time, we see a noticeable change in her character. She has taken the first step outside the safe little prison that has been built around her and begins to take charge of her own life. Crossing the street is a simple act for many people, but when Wendy does it, she is kicking loose bars out of her cage.

When Scottie finally figures out where Wendy has gone, she sets out in pursuit. A scene in which Scottie arrives at a hospital just after Wendy has slipped away is telling: When Scottie becomes upset and starts shouting, a hospital administrator treats her exactly the way Scottie had treated Wendy earlier in the film when Wendy didn't want to study “names and places.” The irony seems lost on Scottie, who seems to feel it’s okay to treat Wendy in ways that Scottie, herself, feels disrespected and violated by. Later, though, Scottie quietly confesses to her teenage son, “I think this is my fault.”

And it is.

It’s not entirely Scottie’s fault that Wendy has run off, but it is Scottie’s fault, and Audrey’s fault, and the fault of the entire system behind the group home, and the eye contact training, and the assumptions of incompetence, that lead authorities to believe that Autistic people cannot engage in supported decision making but must have the details of our lives managed for us by a non-autistic majority, “for our own good.”

I hope you will watch Please Stand By. We need to support films like this so that more films like this (and films even better than this one!) are made. We need to send a clear message that we applaud the positive representation and want to see more of it. And we need to speak about what we liked and disliked about the story and its implementation so that we can help to shape future films to include more Autistic actors in bigger roles, more Autistic writers and directors, more positive representation of Autistic lives, more paid Autistic consultants working in movies and television, and more messages about the value of Autistic lives. Oh, and more Klingon. The world definitely needs more movies with Patton Oswalt speaking Klingon.

Live long and prosper.

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The New Relationship: Living Apart, Together

Macleans.ca  

According to Statistics Canada, approximately 1.9 million Canadians aged 20 and over were in a

Living Apart Together (LAT) arrangement in 2011. It’s not a huge number, but it is growing in

one category—the 60-plus—where it jumped from 1.8 per cent to 2.3 per cent from 2001-11.

(Read full story)

  

Older adults embracing 'living apart, together'

Since 1990, the divorce rate among adults 50 years and older has doubled. This trend, along with longer life expectancy, has resulted in many adults forming new partnerships later in life. A new phenomenon called 'Living Apart Together' (LAT)--an intimate relationship without a shared residence--is gaining popularity as an alternative form of commitment. Researchers say that while the trend is well understood in Europe, it is lesser known in the U.S. This means that challenges, such as how LAT partners can engage in family caregiving or decision-making, could affect family needs.

“What has long been understood about late-in-life relationships is largely based on long-term marriage,” said Jacquelyn Benson, assistant professor in the College of Human Environmental Sciences. “There are now more divorced and widowed adults who are interested in forging new intimate relationships outside the confines of marriage. Recent research demonstrates that there are other ways of establishing long-lasting, high-quality relationships without committing to marriage or living together. However, U.S. society has yet to recognize LAT as a legitimate choice. If more people—young and old, married or not—saw LAT as an option, it might save them from a lot of future heartache.”

Benson and Marilyn Coleman, Curators Professor of Human Development and Family Science, interviewed adults who were at least 60 years old and in committed relationships but lived apart. The researchers found that couples were motivated by desires to stay independent, maintain their own homes, sustain existing family boundaries, and remain financially independent. Couples expressed challenges defining their relationships or choosing terms to properly convey the nature of their relationships to others. For example, the majority considered traditional dating terms such as ‘boyfriend’ and ‘girlfriend’ to be awkward terms to use at their ages.

“While we are learning more about LAT relationships, further research is needed to determine how LAT relationships are related to issues such as health care and caregiving,” Benson said. “Discussions about end-of-life planning and caregiving can be sensitive to talk about; however, LAT couples should make it a priority to have these conversations both as a couple and with their families. Many of us wait until a crisis to address those issues, but in situations like LAT where there are no socially prescribed norms dictating behavior these conversations may be more important than ever.”

Benson is seeking older adults from around the country in committed, monogamous relationships who are choosing to live apart (in a LAT relationship) or living together unmarried (cohabiting). Those willing to participate in her research can email loveafter60lab@missouri.edu. To find out more about Benson’s research, visit www.loveafter60lab.com.

“Older adults developing a preference for living apart together,” was published in the Journal of Marriage and Family. “Older adult descriptions of living apart together,” was published in Family Relations. Benson is the Missouri state specialist in gerontology for the College of Human Environmental Sciences Cooperative Extension.

Story Source:  Materials provided by University of Missouri Health.  Jacquelyn J. Benson, Marilyn Coleman. Older Adult Descriptions of Living Apart Together. Family Relations, 2016

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How Does The HCBS Settings Rule Affect Housing and Day Program Rules and Rights?

Painting © Tracy Booth | Creative Commons/Flickr
[image: Painting of a tiny home with a red roof with
white spots, and a lantern, under a crescent moon]

Many of our U.S.-based community members, including parents and caregivers, want guidance and clarity about how the impending Home and Community Based Services (HCBS) Settings rule will affect both adult housing choices and adult day programs.

So, we spoke with policy expert Julia Bascom, Executive Director of the Autistic Self Advocacy Network, who explained in plain conversational language how exactly the new HCBS Settings rules will affect housing options, how some common misunderstandings about the rule happen, and why the rule is essentially about trying to ensure adults with disabilities have the same basic rights as non-disabled adults do.

Thinking Person's Guide to Autism: Why was the rule enacted in the first place?

Julia Bascom: The HCBS Settings Rule sets ground floor, baseline standards for what qualifies as home and community based services (HCBS). Unlike institutions, which have had basic rules to adhere to for decades, these standards have actually never existed in an enforceable way for HCBS. This has contributed to the problem we're all very familiar with, where "community services" like group homes or day programs can end up being mini-institutions. The settings rule is trying to fix that.

This is important, so I want to dwell on it for a minute. Right now, if someone is on Medicaid and has high enough support needs to qualify for services, they are entitled to receive those services in an institution. That entitlement means there isn't a waiting list—if you need services, you can get them right away, as long as you are willing to give up your freedom and your life in the broader community.

And that's an unacceptable trade-off to ask people to make. By their nature, institutions are extremely restrictive settings. People living in institutions don't get to make their own choices. They have to live by the rules, schedule, meal plan, and decisions made by the instruction. They are segregated and isolated, and that makes them less safe—institutions are hotbeds for abuse and neglect.

In contrast, decades of research shows that people with disabilities living in the community make more choices for ourselves, have a better quality of life, are safer and more included in our communities, live longer, and maintain and develop more skills—and this is true regardless of how disabled a person is or how intense our needs are. Community settings are vastly preferred by people with disabilities and our families, and over the last three decades, there's been a huge push to move people from institutions into the community.

But Medicaid rules haven't kept up with that progress. For example, even though there's no waiting list for a spot in an institution, states are allowed to have wait lists for HCBS. These wait lists can last years, or even decades in some states. So if someone chooses to receive HCBS, they have to waive their right to receive services in an institution (that's why these services are often called "waivers") and then spend years foregoing ANY services while they sit on a waitlist. And right now, over 600,000 people with disabilities and families have made that choices and are currently sitting on a waitlist, with no services, waiting for a spot to open up. That's how popular these services are. That's how badly people with disabilities, including people with the most significant disabilities and our families, want to live in the community.

But prior to the rule, something hideously unfair kept happening. A person with a disability would choose community instead of an institution, spend years on a waitlist without any services, finally get a waiver slot—and end up in a group home or a day program that was exactly like a miniature version of an institution. People theoretically living in the community nonetheless had no choice or control over their own life. They were still segregated and isolated from people without disabilities.

And that's where the HCBS Settings Rule comes in. The rule doesn't close any institutions. If someone wants to live in an institution, they still have that choice. What the rule DOES do is say that if a setting is getting paid to provide home and community based services, they need to actually provide home and community based services.

The new standards in the rule are wild [sarcasm] things like: you can't withhold food from people. The person with a disability gets to make our own schedule. We get a choice between living with other people with disabilities, or living in our own home—and if we chose a group setting, we get to chose our roommate, decorate our room, and lock our door. The rule says we have rights that non-disabled people get to take for granted. That's all. That's the whole thing.

It's also important to point out that it took years to make this rule. The federal government received thousands of comments from people using services, providers, and families, and they had to respond to each and every one. The final rule is a compromise. It sets minimum standards, and it doesn't go as far as self-advocates wanted. Having the right to lock your door or eat when you're hungry isn't radical stuff—it barely scratches the floor of what disabled people deserve. But because the process was so comprehensive, and because the rule does for the first time establish that people receiving HCBS have basic rights, it's supported by the vast majority of national organizations representing people with disabilities and our families, along with hundreds of community providers. It's just a start—but at least we're starting.

TPGA: How long do states and providers have to come into compliance with
the new rule?

Bascom: States and providers have until 2022 to come into compliance. Since the rule was released in 2014, that means they'll have had a total of eight years to get up to speed.

TPGA: Will all adult programs have to change?

Bascom: No. If a community service is good—if it respects people's rights, supports our inclusion in the community, and makes sure that people with disabilities are in charge of how we spend our day—it won't have a problem. If it's not good, but wants to be better, it won't have a problem. If a setting is really dedicated to keeping people with disabilities segregated and subordinate, then it will have to decide to either change, or to find another source of funding.

There's a very limited amount of funding for HCBS services. That's why we have waiting lists. The point of the settings rule is to make sure that those limited dollars are being spent on services that really are home and community based, not services that are just institutions with a new coat of paint. If a setting doesn't meet criteria for HCBS, it can look for institutional funding, or it can switch to private pay. Or it can treat the people it purports to serve fairly. It's up to them.

TPGA: How does this affect adult programs that appear institutional in nature?

Bascom: One of the things that we really like about the rule is that the rule is based on the experiences of people with disabilities living or spending their days in a given setting. So it doesn't do things like set limits on the size of a setting by itself. At the same time,  the rule recognizes the decades of research and lived experience which show that certain types of settings—large congregate settings, or settings that clump a lot of disabled people together and provide a lot of services in one place—are more likely to function as an institution that not. The rule calls these settings "presumptively institutional" settings, or "settings that isolate."

But these settings still aren't banned by the rule! States have a choice. A state can decide to look at settings which, on their face, seem institutional, and give them a chance to prove that they are in fact HCBS. They have to use a process called heightened scrutiny, in which the setting demonstrates that it meets all the criteria. If a setting can prove that the people living there really do keep all their rights, and really are integrated into the broader community, it can keep its HCBS funding. Since the standards are so basic—again, can I eat when I'm hungry, can I lock my door, can I spend my time how I want—this should be pretty easy to prove. If a setting can't meet that baseline, it has no business calling itself HCBS.

TPGA: Does this mean that all clients of adult programs will have to adhere to the same rules without exceptions? What about individualized and competing access needs?

Bascom: Nope! If someone has a disability that means that a certain part of the rule won't work for them (e.g., unrestricted access to food for someone with Prader Willi,) the rule has an exception process that can be done as part of person-centered planning. The flip side, though, is that my exception can't impact someone else's services. If I need to eat on a specific schedule, for example, my provider is no longer allowed to make the whole group home follow that schedule. It's all about what I as an individual person need.

TPGA: How are HCBS rules affecting adult day programs different from those affecting residential programs?

Bascom: There's more clarity around residential services than day services right now. States have a huge amount of flexibility under the rule, so some day programs in progressive states are changing how they operate, to ensure that people set their own schedules and don't spend all day in a facility. By 2022, all adult day programs will have had eight years to figure out any changes. And again, good programs that work to integrate people into their communities and either find employment or do other things during the day that are meaningful to them, won't have to make any changes at all.

TPGA: So why do you think some people might be opposed to the HCBS rules for adult day programs?

Bascom: I think there are a few different reasons. A lot of people are just confused, because there's so much misinformation flying around about the rule. There are also people deliberately spreading this misinformation, and they tend to have a couple different reasons.

First, there are providers who have a vested financial interest in operating miniature institutions and calling it HCBS. There are actually a lot of rules about running formal institutions—there are basic standards you have to follow, licensing regulations, all of that kind of thing. But those rules haven't really existed before in that same way for HCBS. That means a lot of these providers have been able to run mini-institutions for decades with virtually zero regulation or oversight. They aren't wild about changing. This is, bluntly, too bad.

There are also a lot of wealthy families who want to build new institutions. They don't like to call them institutions—they call them farmsteads, or intentional communities, or campuses, or villages. But these are all literally what the first institutions looked like, and they are still large settings that lump a lot of disabled people together and segregate us from the broader community. It's a fresh coat of paint on a bad idea. But these families want to build them, and they've invested a lot of money in their construction, and now they're worried that Medicaid won't pay for services in these settings. So they oppose the rule.

There are also people who are worried that their family member can't live in the community. We know that community living is actually possible and beneficial for everyone, even for people with the most significant disabilities, but I think some families are afraid to take the plunge, especially if they haven't seen a lot of successful examples of people like their family member living good lives in the community. These families aren't helped by misinformation—they need concrete examples of how this works, like those in parent/professional Dr. Clarissa Kripke's article on successful community living for people with developmental disabilities.

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Things I Already Know: A Review of ‘Things I Should Have Known’ by Claire LaZebenik

Kate Ryan

[image: Cover of the book "Things I Should Have
Known" by Claire LaZebnik: A dark blue background
with "Things I should Have Known and the author's
name in all-caps, handwritten text. Parts of the title
are scribbled out in pink, so the title reads,
"Things I Know."]

When I scanned the inside cover of Claire LaZebenik’s novel Things I Should Have Known, I knew that I was going to read this book. Not because it sounded particularly interesting, but because one of the main characters was autistic, and that always intrigues me because I am autistic myself.

I opened the book on a sunny Saturday afternoon—with trepidation, because 99% of the time, autism (and other disabilities) in fiction are portrayed terribly and then I want to retch at the end. Young adult books, which is this book's category, are particularly liable to being not just ignorant about disability, but genuinely bad.

That being said, I was pleasantly surprised by this book, because it wasn’t terrible. It was bland and predictable, and the writing was not especially good, but the author clearly knows autism—and autism was not the villain in the story.

Things I Should Have Known centers around Chloe and Ivy, sisters aged 17 and 20. They live in Los Angeles, California, where Chloe leads the perfect life: she is blonde, skinny despite eating terribly and never exercising, has a rich, handsome boyfriend, and is smart enough to be in honors classes. That’s it, though: we are never told her hobbies, interests, dreams, or anything to really flesh out the character as a living person. Chloe’s life revolves around being perfect and taking care of her sister, and that’s it.

Ivy is 20, plain in appearance, likes watching television and playing on her iPad, and goes to a special needs school.  Ivy is verbal but struggles with many things that autistic people struggle with, such as social communication and changes in routine. LaZebnik definitely seems to ‘get’ how incredibly hard autistic people try all day long to be "normal," and how incredibly exhausting and anxiety-provoking it is.

Chloe shows real empathy towards her sister and gets it in return. Ivy clearly adores Chloe and depends on her, while at the same time, she makes deliberate efforts to be the older sister that she knows she is, and to comfort and help Chloe in times of need. Ivy is constantly seeking Chloe’s approval and changing herself to please her sister, such as getting her hair cut and highlighted at Chloe’s suggestion, even though haircuts hurt for her. If you think autistic people are not capable of empathy, then you have not met Ivy.

Unfortunately, it seems like LaZebnik was so busy making sure that Ivy was a fully-fledged person, she forgot that Chloe should be one, too, especially since it is told from Chloe’s point of view.  She equally fails with the character of David, who is the younger brother of Ethan. It turns out Ethan and Ivy have been in the same class for years, as have Chloe and David, but they never realize this until Chloe decides that Ivy needs a boyfriend and starts planning social outings. David, being a dutiful younger sibling even more than Chloe is, comes along, and he and Chloe are soon on the path to a weird romance that we are never given any reason should exist, because both of the characters are flat as paper.

One thing that this book does well is that it portrays autistic people as fully-fledged human beings with ideas and interests of their own, who are constantly being forced into boxes by well-meaning non-autistic people. Even though Ivy is not interested in Ethan, she wants to please her sister so much that she goes along with her plans. One thing that this book does not do well, however, is in its portrayal of autistic people as sweet, good, innocent and incapable of anger. Ivy gets confused and tearful when Chloe is shouting and ranting. And Ethan is almost a stooge, a caricature of your typical autistic male. He wants to be Ivy’s boyfriend and sets out to do so by following the rules set out for him by David, such as paying for snacks, participating in activities, and he shows his own devotion to being a ‘real’ boyfriend by doing research on topics that Ivy has interest in.

~Here there be spoilers~

Unfortunately, Ethan ends up getting dumped by Ivy because it turns out that Ivy, like many people on the spectrum, is gay; plus she never really thought that she and Ethan were dating in the first place; she was just going along with what her sister wanted. But being dumped so upsets Ethan that he does a runner and bolts, and his parents then decide to send him away to a boarding school.

Although Chloe and David, who are by this time full-fledged boyfriend and girlfriend despite not having any chemistry whatsoever, are devastated, Ivy does not seem to have any particular feelings about this turn of events. David is convinced that wherever Ethan has been sent to, it is a torturous pit of snakes, and is very surprised when he and Ivy visit and find nothing of the sort. Instead it seems like a college campus where young autistic adults are supported and go to classes and are encouraged in their own pursuits.

This is one of the things that rings most untrue to me: David’s parents, instead of hiring more support staff or sending Ethan to a weekly boarding school, were able to—in a matter of days—get him admitted to this fantastic institution (for it is an institution, locked gates and all) where he never comes home from and where his only visitors are Chloe, David and Ivy.

David accepts that it is possible his brother is happy without him, in a place where he gets lots of support and has opportunities that he lacked at home, but to me, this section seemed like it was in support of sending autistic people away from their families when they got to be "too challenging" in their behaviors. This was really sad. We should be moving away from institutions, not towards them. (Also, where does David’s family get the money for this? They do not seem to be particularly well off, but they must be secretly rich or something. And if they were secretly rich, why were they depending on David for years to be his brother’s only companion instead of hiring a personal care aide?)

I felt weird about this book. Judging by the reviews it got online, people are raving about it. But it is clear to me that that book was written for siblings of those on the spectrum or for those people who don’t know anything about autism; it wasn’t written for autistic people or autistic teenagers, who I think could seriously use a book where they found themselves portrayed accurately. For now, we will have to rely on memoirs, not fiction, for that.

I definitely liked parts of it, such as when David and Chloe explain exactly why vaccines do not cause autism, or when Chloe muses about how hard Ivy works all the time to appear ‘normal’ despite the fact that she is experiencing horrible, constant anxiety. But other parts just fell flat.

I think perhaps the author was too intent on educating people about autism, and how it isn’t a death sentence and not intent enough on writing a good book. There was a lot of dialogue, a lot of telling, not showing. LaZebnik was careful to dispel myths about autism but didn’t care that she’d made Chloe into a most stereotypical valley girl, blonde highlights and all. We know that Chloe cares about Ivy, David and Ethan, but whether or not she cares about anyone or anything else, we never find out.

Overall, I would recommend this book, especially to teen siblings of those on the spectrum, but I would read it alongside a teen on the spectrum and discuss it with them to make sure that they understand that Ivy and Ethan are no more your average autistic person than Temple Grandin is. There wasn’t any new information for me in the book, but I can definitely see how people who don’t know many autistic people (and you should, because we’re awesome!) would benefit from reading it.

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#AutisticWhileBlack: To Siri With Love's Shallow, Dangerous Take on Forced Sterilization

Kerima Çevik
intersecteddisability.blogspot.com
theautismwars.blogspot.com

Kerima Çevik, photo courtesy the author
[image: Gray haired Afro-Latina woman
next to a windowshade, looking to the left.]

[Content note: Contains descriptions of involuntary medical procedure, including sterilization, on Black and disabled people.]

I am trying to plow my way through Judith Newman's autism parenting book To Siri with Love: A Mother, Her Autistic Son, and the Kindness of Machines. It is slow, painful reading.

How can I explain my serious ethical concerns about yet another bestselling autism book that capitalizes on presenting the experience of disability from a parent's reduction of a disabled individual’s worth to how he makes his mother and those around them feel?

I can tell you that Newman's passage about looking forward to acquiring a medical power of attorney so she could involuntarily sterilize her autistic son Gus tainted the rest of the book for me. A vasectomy, she says. That passage has so much wrong packed into it that shocks, frightens and disturbs me as both a Black woman, and the parent of a nonspeaking autistic teenaged son of color.

I read what Newman wrote, and the years of harm to the black body—borne by my entire race—burst open like a septic wound. Combined with a year of escalation in harm to our people, it was just too much.

Newman writes about looking forward to being able to sterilize her child. This sent chills down my spine. The presumption that Gus might inadvertently father a child, and that this would be some sort of calamity, is both extremely ableist and demonstrates a clear disdain for any potential her son might have to lead the autonomous, inclusive community-based life that is the legal and human right of every disabled adult in our society.

Newman's assumption presents the disabled young adult as passive and inept, when in reality parents are responsible for ensuring that our children's primary life skills include sex education that might protect them from abuse and harm. This need, and the realities about sexual assault of disabled children and adults were featured in a recent NPR series, with statistics that tell a frightening story of helplessness and cyclic abuse because we insist on viewing our own children as having to be 'fixed,' rather than educated, and taught boundaries and self-protection.

Sex education for neurodivergent youth and adults exists. These courses teach students all they need to know about of their own bodies, setting and respecting boundaries, reproduction, self-care, and how to avoid harm in accessible language.

The author writes that she avails herself of access to autistic adults willing to be information resources, yet displays a lack of information about the existing resources for her son to navigate higher education and other aspects of life as a disabled adult. This contradiction in her book is confusing, as well as disturbing.

Gus might turn out to be a more patient, kinder, and understanding parent because he knows what it means to be disabled and subjected to maltreatment as a result. Gus may choose not to be a parent because he knows what it means to be disabled and subjected to maltreatment as a result. Gus is able to speak for himself. The choice, with supported decision-making if he needs it, should be his.

Forced sterilization is part of a larger nightmare of systemic abuse of the black body we've survived but can't forget. The practice of modern gynecology was built on the torturing of the black female body, without the benefit of anesthesia. J Marion Simms cut away at our ancestors' bodies, forcing slave women to hold down their fellow helpless enslaved victims while he did horrible surgeries on them. He brushed aside protests and outcry, by insisting that our women could not feel pain.

He is hailed as a great man. Statues stand in his honor.

Ms. Newman cannot feel what that legacy does to people. She blithely brushes it off in a great hat trick of compartmentalization, secure in her mistaken idea that all parents agree with her view of their disabled children. I beg to disagree. This parent does not hold Ms. Newman’s view of disabled children.

"Mississippi Appendectomy"

See, I can't forget what happened to Fannie Lou Hamer and the African American women of Sunflower County, Mississippi:

"Diagnosed with a small uterine tumor in 1961, Ms. Hamer checked into the Sunflower City Hospital to have it removed. Without her knowledge or consent, without any indication of medical necessity, the operating physician took the liberty of performing a complete hysterectomy.

"Three years later, as a leader of the Mississippi Freedom Democratic Party, Ms. Hamer spoke about her experience to an audience in Washington D.C. – telling them that she was one of many black women in her area that had been a victim of a “Mississippi appendectomy” (an unwanted, unrequested and unwarranted hysterectomy given to poor and unsuspecting Black women). According to her research, 60% of the black women in Sunflower County, Mississippi were subjected to postpartum sterilizations at Sunflower City Hospital without their permission. A number of physicians who examined these women after the procedure was performed confirm that the practice of sterilizing Southern Black women through trickery or deceit was widespread."

Even if Newman claims she's changed her mind now, even if she chose to retract that vile passage from all future copies of her book, this random musing of Ms. Newman's has opened the floodgates to dangerous thinking. Involuntary sterilization is not an idea that should be recirculated in a time of resurgent racism, and vile ableism. It is not an idea that should reemerge in an environment where disabled parents must constantly fight to keep custody of their own children. It should not be introduced to parents as some sort of justifiable option, particularly couched in literary sarcasm or humor, in a nation where Buck v. Bell has not yet been overturned.

Though in the book Newman gives a partial checklist overview of the history of disability and sterilization, she never mentions Buck v. Bell. How is this possible?" Every parent of a neurodivergent offspring in America should know about Buck v Bell, the harm visited upon innocents because of it, and the potential harm that can still be done to others because of it. Here:

Buck v. Bell, 274 U.S. 200 (1927) is a decision of the United States Supreme Court, written by Justice Oliver Wendell Holmes, Jr., in which the Court ruled that a state statute permitting compulsory sterilization of the unfit, including the intellectually disabled, "for the protection and health of the state" did not violate the Due Process clause of the Fourteenth Amendment to the United States Constitution. The decision was largely seen as an endorsement of negative eugenics—the attempt to improve the human race by eliminating "defectives" from the gene pool. The Supreme Court has never expressly overturned Buck v. Bell.

Buck v. Bell allowed the forced sterilization of a neurodivergent young woman and her 52-year-old disabled mother. Buck v. Bell was used to justify thousands of forced sterilizations of disabled people. Then came the thousands of forced sterilizations of African American women and African American girls who were raped. That escalated into the forced sterilization of poor white males and females. Forced sterilization continues today:

"A 2013 report from the Center for Investigative Reporting found that in California between the late 1990s and 2010, hundreds of female prisoners were sterilized without proper state approval. As a result of the investigation, Governor Jerry Brown signed a law banning forced sterilizations in the California prison system."

In 1986, Canada had its own Buck v. Bell moment. It was called the Eve decision, and it ensures forced sterilization doesn't happen there. Perhaps it is time to challenge and defeat Buck v. Bell in the U.S. Perhaps it is too late. But we should all be afraid because forced sterilization has already happened here, and continues to happen.

In her one unfortunate passage, Ms. Newman may have opened Pandora's box.

Here's what disturbs me the most: Our children aren't dogs or cats. They are human beings who need varying degrees of support. Now that you all know what was done to people of color, disabled people, and other marginalized groups, try to feel our distress. Don't treat disabled human beings, your own children, as othered creatures to be de-barked, spayed or neutered into compliance for our convenience. We know in our hearts this path is wrong. This is not something to daydream about or look forward to doing. This is a eugenics rabbit hole.

Literature shapes societal attitudes. What we write in the Internet age, particularly when content creators have as massive a platform as Ms. Newman has, can change the fate of thousands of autistic teens and young adults. We are their parents. Not their wardens, overlords, or owners. What we write can lead to events and public policy changes that might literally make their lives hell on earth.

We are living in a nation grappling with a chief executive who has recorded incidences of racially disparaging and ableist remarks, and who is trying to legislate based upon his personal biases. His remarks have enabled a harmful nationwide attitude shift, and as a result people are moving from vocalizing bigotry to acting on it. We have also seen escalated attempts to enact major changes in public policy, changes that may cause unprecedented harm to disabled people, people of color, and multiply-marginalized groups.

This means all parents authoring autism-related content must think about the consequences of what they write, before rushing to look for provocative vignettes for their bestsellers.

People took the right of consent from us for generations because they didn't like our color. They believed our race was 'defective.' All these unjust, stereotypical labels are being hung on our disabled children now. I cannot accept my son’s right to agency in his own life being taken from him and his people, because some author couldn’t imagine a world where her son has the competence to decide his own fate. It is her obligation as his mother to take the actions necessary to ensure he gains the skills required to gain such agency.

To me, seeing this book written from the perspective of white privilege, yet much-lauded, and hailed as witty, honest, and moving, is heartbreaking.

But unlike Ms. Newman, I won't generalize and assert that other parents in the autism community agree with me.

----

Resources:

The Sexual Assault Epidemic No One Talks About
https://www.npr.org/2018/01/08/570224090/the-sexual-assault-epidemic-no-one-talks-about

The Negro Project
https://www.nyu.edu/projects/sanger/articles/bc_or_race_control.php

Literal Silencing
http://www.autistichoya.com/2013/09/literal-silencing.html

Rocking the Cradle: Ensuring the Rights of Parents with Disabilities and Their Children
https://www.ncd.gov/publications/2012/Sep272012

Buck v. Bell
https://supreme.justia.com/cases/federal/us/274/200/case.html
https://www.democracynow.org/2016/3/17/buck_v_bell_inside_the_scotus

The Eve Decision: Why Forced Sterilization is not a fear in Canada
(with thanks to Emma van der Klift)
https://cic.arts.ubc.ca/the-eve-decision-1986/

Authoring Autism
https://www.dukeupress.edu/authoring-autism
Professor Melanie Yergeau's book addresses the ways literature is used to present stereotypes that dehumanize autistic characters, thus perpetuating structural ableism.

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How Extreme Diets Damage Autistic People

Reid Knight

Note: This article contains discussion of disordered eating.

Photo by Mr. Gray | Flickr, Public Domain
[image: Motel sign advertising "Gluten Free Wifi"]

For many parents of a newly-diagnosed autistic child, a quick internet search for 'autism' tells them that changing their child’s diet is a smart first step towards “improving” autistic behaviors or other co-occuring conditions. Despite the popularity of “autism diets,” research shows insufficient proof that they do anything positive at all. Nevertheless, strictly regimenting the diet of autistic children continues to be a common parental practice.

I was one of those autistic children who got put on a special diet, by parents who thought they were doing what was best for me. Though parents like mine may believe such a controlled diet is for the benefit of their child, my own experience on an autism diet was that it led to permanent harm.

Growing up, I was not allowed to eat a laundry list of seemingly random foods: dairy, sesame seeds, mangoes, peanuts, whole wheat. In order to avoid explaining my autism diagnosis to me, my parents simply told me I was “allergic” to these foods. Because I grew up in a time before dairy-free substitutes were readily available, I vividly remember feeling like I was missing out: While my friends got to enjoy pizza and cake at birthday parties, I got stuck with a turkey sandwich.

Eventually, I realized that when I did eat the foods I was supposedly “allergic” to, nothing happened. Eating pizza and ice cream didn’t make me sick, or change how I acted or felt. And when I realized the only thing stopping me from eating pizza and ice cream was my parents, I began to distrust them. No child should have to experience that. This was also when my unhealthy relationship with food began.

When realized I wasn’t allergic to any foods, I wanted to eat them all. I began to binge-eat at any events where my parents weren’t monitoring me. I would eat a whole pizza at birthday parties, or use my school lunch money to buy as many chocolate chip cookies as I could. As I got older, I would buy food and sneak it back into my room, where I would eat when my parents were sleeping. I felt like I had to keep what I ate a secret. I felt ashamed for eating.

As an adult, I now have full freedom over what I eat, and when. But I still worry that I could lose that control of what food I am allowed, at any time. This leads to periods where I’ll binge-eat for days, then feel ashamed for doing so, then heavily restrict what I eat for the following days. I know that this is unhealthy. I also think a lot of theses negative feelings and behaviors around food could have been avoided had I not been put on an autism diet.

Another tactic often used as a part of “evidence-based” autism treatments and behavioral therapies, and one I also experienced, is encouraging parents to restrict a child’s favorite or staple foods. For example, if an autistic child loves chicken nuggets and will refuse to eat anything else for dinner, a parent may be encouraged to stop feeding their child chicken nuggets altogether and force them to eat something else, or to save chicken nuggets to only be used as a reward for good behavior.

Even if these food restriction methods lead to better behavior from a child, they are still harmful to that child’s relationship with food. Like a certain stim behavior or comfort object, specific foods can be a source of security for autistic people. In addition, difficulties with certain textures or other sensations can make certain foods inedible or even disgusting to us. By forcing children to give up their favorite foods in exchange for foods they may not even be able to stomach, children may develop a love-hate relationship with eating.

My “positive reinforcer” was ice cream. Every time I did something I hated, I was taken for ice cream afterwards, which means I associated pain with ice cream. And now, as an adult, when something goes wrong in my life my first instinct is still to eat something to feel better. This isn’t a healthy way to think about food, and isn’t what we should be teaching autistic children.

Emerging research indicates that many people in the autistic community struggle with eating disorders. The news was saddening, but not surprising. When food restriction is such a common “treatment” for autism, it is almost inevitable that some of us develop disordered eating as adults. There has been no research to explore the link between autism diets and the high rate of co-occurring eating disorders in the autistic community. I think it’s a topic worthy of further investigation.

I am not encouraging parents to take a hands-off approach to what their children eat. Parents should have open conversations with their autistic children about food: The importance of trying new foods (at the child’s own pace), eating unhealthy foods in moderation, and focusing on how your body feels when eating different foods. Parents should also actively involve their kids in choices about what foods to eat, as well as shopping for and cooking the food, to teach them that they have autonomy while also learning the skills for independent living.

Food is an important part of life. Instead of using food as a “positive reinforcer,” or as part of a cure attempt, parents can use food and conversations about food to connect with their autistic children. Maybe my relationship with ice cream, and food in general, could have been different.

----

A version of this article was previously published at NOS Magazine.

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Homosexuality May Help Us Bond

medium.com

It’s a sign of great character development and exposition that Richard

Hatch is never remembered as the gay winner of Survivor and simply

as the first winner of Survivor.  Richard was absolutely loathed by a 

large part of the audience but it was never because he was gay. It was

simply because he was depicted as a cold-hearted villain. (Full article)

The subject of homosexuality has changed so much over the past fifty years.  When I was in the service during Vietnam, a homosexual in the military faced a prison term and a dishonorable discharge just for being who they were.

But time changed.  When a good friend from those days came out to me as gay in 1980, all I could say was to quote the immortal Inspector Jacques Clouseau from Blake Edwards's The Pink Panther series, "I knew that." Today, not really that big a deal, though it still takes courage and self-awareness to state what may be obvious to others.

But why are people homosexual?  What advantage does homosexuality give the human race?  Frankly, it wouldn't exist if there weren't something about it that helps the genus homo survive.  This research may be the start of an answer.

As always, the more a writer knows about the human animal, the truer and more realistic their work will be

*  *  *  *  *

Homosexuality may help us bond

Homosexual behavior may have evolved to promote social bonding in humans, according to new research. Researchers found that heterosexual women who have higher levels of progesterone are more likely to be open to the idea of engaging in sexual behavior with other women. Similarly, when heterosexual men are subtly reminded of the importance of having male friends and allies, they report more positive attitudes toward engaging in sexual behavior with other men. This pattern is particularly dramatic in men who have high levels of progesterone.

The results of a preliminary study provide the first evidence that our need to bond with others increases our openness to engaging in homosexual behavior.

Dr Diana Fleischman, of the University of Portsmouth, and colleagues examined the relationship between progesterone and sexual attitudes to explore the role that homosexual behavior may have played in cementing alliances over the course of human evolution.  Their research is published in the journal Archives of Sexual Behavior.

They found that heterosexual women who have higher levels of progesterone are more likely to be open to the idea of engaging in sexual behavior with other women. Similarly, when heterosexual men are subtly reminded of the importance of having male friends and allies, they report more positive attitudes toward engaging in sexual behavior with other men. This pattern is particularly dramatic in men who have high levels of progesterone.

The hormone progesterone is known to contribute to the formation of social bonds, which have many adaptive benefits for humans. The hormone is produced mainly in the ovaries in women and in the adrenal glands in men. It is one of the main hormones responsible for caring or friendly behavior and levels rise when people have close and friendly interactions. Women's levels of progesterone peak after ovulation when the chance of becoming pregnant is dramatically reduced.

Dr Fleischman said: "From an evolutionary perspective we tend to think of sexual behavior as a means to an end for reproduction. However, because sexual behavior is intimate and pleasurable, it is also used in many species, including non-human primates, to help form and maintain social bonds.  We can all see this in romantic couples who bond by engaging in sexual behavior even when reproduction is not possible.

"The results of our study are compelling because using two very different methods, they arrived at the same conclusion. Women were more likely to be motivated to think about homosexual sex when their levels of progesterone were higher. Compared to a control group, men's homoerotic motivation was not increased by priming them with sex but thinking about friendship and bonding caused a measurable change in their attitude to the idea of having sex with other men." Having homoerotic thoughts does not necessarily mean they would be acted upon.

Dr Fleischman, an expert in the influences of hormones on the psychology of women, was studying the effect of progesterone on attitudes towards homosexuality. She questioned whether progesterone, a hormone that has been shown to increase motivation to form close bonds, might also underlie the motivation to affiliate with those of the same sex, sexually.

The researchers first developed a measure of homoerotic motivation through an online survey of 244 participants, with questions including: 'The idea of kissing a person of the same sex is sexually arousing to me' and 'If someone of the same sex made a pass at me I would be disgusted'. The researchers then measured progesterone in 92 women's saliva and found that as progesterone increased so too did openness to the idea of engaging in homosexual activity.

In the next study, the researchers measured levels of progesterone in the saliva of 59 men before all were randomly assigned to one of three groups and asked to complete word completion puzzles, one using friendship words, one using sexual words, and a third using neutral words. Men asked to complete the affiliative/friendship word puzzle showed 26 per cent greater homoerotic motivation compared to the men in the sexual or neutral conditions. In addition, those men with the highest progesterone in the affiliative condition showed 41 per cent greater homoerotic motivation compared to high progesterone men in the other two groups.

Studies of other animals in the great ape family also point to homosexual behavior being used to maintain and forge new friendships.

Dr Fleischman said: "Humans are among a group of animals who have sex for many reasons, not just to reproduce. Reasons can include pleasure, a reward, a way of saying 'please be nice to me' or exerting dominance. It's very complex, but it's clear there's a continuum between affection and sexuality and sexuality is fluidity, that is, the ability to engage sexually with those of the same sex or the opposite sex is common. In humans, much, if not most of same-sex sexual behavior occurs in those who don't identify as homosexual."

The researchers will now explore other contexts and hormonal influences that could increase homoerotic motivation in men and women. They are also interested in seeing how bisexual people might react differently to social cues.

Story Source:  Materials provided by University of Portsmouth.  Diana S. Fleischman, Daniel M. T. Fessler, Argine Evelyn Cholakians. Testing the Affiliation Hypothesis of Homoerotic Motivation in Humans: The Effects of Progesterone and Priming. Archives of Sexual Behavior, November 2014.

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The costs & risks to transgender women

Source:  Are men afraid of transgender women?  The Telegraph 

Psychiatric diagnoses in young transgender women

About 41 percent of young transgender women had one or more mental health or substance dependence diagnoses and nearly 1 in 5 had two or more psychiatric diagnoses in a study of participants enrolled in a human immunodeficiency virus (HIV) prevention intervention trial, according to an article.

Transgender youth -- including adolescent and young adult transgender women assigned a male sex at birth who identify as girls, women, transgender women, transfemale, male-to-female or another diverse gender identity on the transfeminine spectrum -- are a vulnerable population at risk for negative mental health and substance use outcomes.

Sari L. Resiner, Sc.D., of Boston Children's Hospital/Harvard Medical School, Boston, and coauthors used a diagnostic interview in an at-risk sample of young transgender women to assess the prevalence of mental health, substance dependence and coexisting psychiatric disorders.

The study included 298 sexually active transgender women (ages 16 through 29) enrolled in Project LifeSkills in Chicago and Boston. Nearly three-quarters of the study group was unemployed and nearly half had an annual income of less than $10,000.

The authors report prevalence for:

• Lifetime and current major depressive episodes were 35.4 percent and 14.7 percent, respectively
• Past 30-day suicidality was 20.2 percent
• Past 6-month generalized anxiety disorder and posttraumatic stress disorder were 7.9 percent and 9.8 percent, respectively
• Past 12-month alcohol dependence and nonalcohol psychoactive substance use were 11.2 percent and 15.2 percent, respectively
• The prevalence of mental health diagnoses by race was significant for lifetime and current major depressive disorder, with Latina young transgender women having the highest prevalence at 48.6 percent and 27 percent, respectively.

The study notes limitations, including that it enrolled participants with sexually risky behavior in an HIV prevention efficacy trial and, as such, the results are not generalizable to the general U.S. population of young transgender women.

"Culturally tailored interventions that work to decrease mental health distress and substance use among young transgender women are needed, as are longitudinal cohort studies that examine the course of mental and physical health of young transgender women over time across adolescence and young adulthood to inform interventions for this at-risk group of youth."

Editorial: Mental Health Disparities Among Transgender Youth

"The entire framework of transgender health care would benefit from a restructuring to meet the needs of patients and clients, as well as acknowledging pragmatic limitations of available professionals," writes Johanna Olson-Kennedy, M.D., of Children's Hospital Los Angeles, in a related editorial.


Story Source:  Materials provided by The JAMA Network Journals.  

1. Johanna Olson-Kennedy. Mental Health Disparities Among Transgender Youth. JAMA Pediatrics, 2016.
2. Sari L. Reisner, Katie B. Biello, Jaclyn M. White Hughto, Lisa Kuhns, Kenneth H. Mayer, Robert Garofalo, Matthew J. Mimiaga. Psychiatric Diagnoses and Comorbidities in a Diverse, Multicity Cohort of Young Transgender Women. JAMA Pediatrics, 2016.

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Why we keep difficult people in our lives

Stan quite regularly annoyed Ollie to distraction - repeatedly in every film.  Yet they

remained close friends - on screen and in real life.  What is it about a difficult person

that makes us keep them around?

Why we keep difficult people in our lives

Close kin, especially female relatives and aging

parents, were most likely to be listed as "difficult."

Chances are, you have someone in your life who causes a lot of tension and stress. Difficult relationships are common. They are also commonly difficult to evade. Who are these people and why can't we just cut the cord?  New research explores these questions and sheds light on the answers. Plain and simple: They are people you are stuck with, either because you need them or because you can't ignore them.

"The results suggest that difficult people are likely to be found in contexts where people have less freedom to pick and choose their associates," says Dr. Shira Offer, of the Department of Sociology and Anthropology at Bar-Ilan University, who co-authored the article with Prof. Claude Fischer, of the University of California at Berkeley.

Yes, that often means family and coworkers.

Offer and Fischer published their findings in a recent issue of American Sociological Review. Their research is based on data from the University of California Network Study, which collected data about the social ties of over 1,100 adults in the greater San Francisco Bay Area.

Respondents in the survey were asked to provide the names of people to whom they were connected in different ways, for example those with whom they socialized, in whom they confided, and from whom they would ask for help in emergency situations. They were also asked to name and describe the people in their lives they found demanding or difficult. The "difficult" comprised about 15 percent of all the people respondents named.

Close kin, especially female relatives and aging parents, were most likely to be listed as "difficult."

"These are people with whom our lives are so complexly intertwined," says Dr. Offer. "Many are close family whom we need and even love; others we just can't escape. Social norms do not allow us to simply walk away from them, however much this might be tempting to do sometimes."

The disproportionate presence of women on the "difficult" list is best understood as reflecting women's more intensive role in the family, providing more fodder for tension and conflict. Non-kin described as friends were less likely and those described as co-workers more likely to be named as difficult.

Finally, the study examined what kinds of interactions seemed to characterize a "difficult" relationship. Providing support to other people, but not receiving support from them - say, caring for a failing parent - was a major source of difficulty in these relationships.

Overall, this study highlights how normative and institutional constraints may force people to retain difficult and demanding connections in their networks.

Story Source:  Materials provided by Bar-Ilan University.  Shira Offer, Claude S. Fischer. Difficult People: Who Is Perceived to Be Demanding in Personal Networks and Why Are They There? American Sociological Review, 2017

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Eye Contact

Beth Wilson
www.doodlebeth.com

[image description & transcription: A full-color hand-drawn comic strip.

The first row contains two panels.

The left hand panel has a green background. A blond white person on the left is talking and maintaining eye contact with the olive-skinned person with long dark hair on the right. Black all-caps hand-lettered text on a white background above their heads reads:

“For allistic people (non-autistic) eye contact is a way of connecting with others in conversation.”

The right hand panel has a blue background. On the left A black person with a natural hairstyle is looking down, with an uncomfortable expression on their face while on the right a white person with long straight hot pink hair and bangs has their eyes closed tightly. Black all-caps hand-lettered text on a white background above their heads reads:

“For autistic people, it’s different. Eye contact is uncomfortable and invasive.”

The second row is a black rectangle with white hand-lettered all-caps text reading:

“When we look away, it doesn’t mean that we are not listening. We are not disrespecting you.”

The third row is one large panel. It is a close up of the eyes and nose of a white person with straight long purple hair and bangs, with eyes wide open. Black all-caps hand-lettered text on a white background at the top of the panel reads:

“If we try and make eye contact with people, it can totally distract us from what is being said because of how horrible it can feel and the effort involved.”

Red-outlined word bubbles around the edge of the panel, in black all-caps hand-lettered text on a white background, read:

“Keep looking” “Having I looked too much?” “This hurts” “Am I doing this right?” “I have no idea what they’re saying” “Can’t do this” and “I feel so vulnerable”

All caps hand-lettered black text under the panel reads:

“© Beth Wilson 2017”

The fourth row contains two panels.

The left hand panel has a light blue background, and contains lack all-caps hand-lettered text on a white background. The text reads:

“Many of us can fake it by looking at details.”

The right hand panel has a pink background. It contains a close-up of a white person’s nose and open mouth. In the upper left corner of the panel, black all-caps hand-lettered text on a white background reads:

“Mouths”

The fifth row contains two panels.

The left hand panel contains a close up of the eye of an olive-skinned person’s wearing teal-framed glasses. In the upper right, black all-caps hand-lettered text on a white background reads:

“Glasses”

The right hand panel has an orange background. Black all-caps hand-lettered text on a white background reads:

“For others, even looking at a face is too much.”

The sixth row contains a single panel with a green background. It contains a South Asian person with short black hair on the left. They are looking at the white person with blue-and-purple layered hair on the right, while that person is looking away. Both are smiling. At the top of the panel, black all-caps hand-lettered text on a white background reads:

“When an allistic person demands eye contact from an autistic person, they are asking for something that only benefits them. Why should we experience discomfort for you?”

At the bottom of the panel, black all-caps hand-lettered text on a white background reads:

“Please respect our need to look away.”

All caps hand-lettered black text under the panel reads:

“© Beth Wilson 2017☆”]

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This comic was originally published at doodlebeth.com.

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Happy (Autism Diagnosis) Anniversary

Chris Williams
medium.com/@Marrowsky

Hello. My name is Chris Williams. Nice to meet you.

I recently celebrated an anniversary. If you’re reading this, thank you for letting me share it with you.

On January 7th of 2017, my doctor telephoned. My screening, my tests, my questionnaires, and interviews with my family had been reviewed and evaluated. My diagnosis was in the mail. “…Chris demonstrates pattern of behavior and impairment consistent with Autism Spectrum Disorder 299.00 (F84.)…”

I’ll introduce myself again, for the first time:

Hello. My name is Chris Williams, and I’m autistic. Nice to meet you.

My diagnosis was, it still is, mind boggling to me. Perhaps to those of you who know me. Perhaps not. To have a paradigm shift, at thirty-six years old, in self reflection, and in reflection about my personal relationships. My memories now telling me different stories. An awfully familiar stranger resembling me in mirrors. My internal cartography reordering itself, patterns forming across my strengths, my weaknesses, my ways of learning, my ways of thinking, and my ways of communicating. It’s been a cacophony of a change of perspective.

Outside my self, my genetics, looking forward and looking backwards, have been concurrent labyrinths to explore. My almost-seven-year-old daughter Calliope* is diagnosed autistic, and has significant support needs. At this time, she’s our only child with a professional diagnosis. In time, I’m confident she won’t be the only one. I’m 95% certain Caspian is; Catherina, perhaps closer to 35% sure. And casting a wider net onto my mother’s family, and onto my father’s reveals traits, behaviors, and whole individuals in different lights. Even friends start to take on new forms or more fully realized shapes, once you know the diagnostic criteria and prevalence of the condition, and not with an unreasonable eye.

You see, 1 in 68 people in the United States are estimated to be on the spectrum, and there’s talk that this is a low estimate. In his 2015 masterwork on autism, NeuroTribes, Steve Silberman writes: “…given current estimates of prevalence, autistic people constitute one of the largest minorities in the world. There are roughly as many people on the spectrum in America as there are Jews.”

That means there’s a lot of us out there. Out there in the open. Hiding within ourselves. Hiding from ourselves. Some of you reading this, maybe there’s some real questions you need to ask—or context you never thought to provide—about yourself to yourself. Or maybe about your spouse, your children, your parents, your brother or sister, your aunt or uncle, your friends, your coworkers. Maybe you'll consider that people are built in strange ways, ones you wouldn’t expect to be so unifying. It’s a revealing thread of humanity to understand, and be attuned to.

It’s funny. Despite Calliope's limited language, she has communicated more to me about myself, my family, and how to regard other humans than anyone I’ve known. She inspired me to learn, she inspired me to self-realize, she inspired me to seek my diagnosis, and now she’s inspiring me to stand tall and make my own truths plain for others to see. She is my skeleton key, my Rosetta Stone, my North Star in this journey.

It’s been a good year in this regard. With my vision unclouded about the best version of my self I can be, I stride towards the future with greater purpose. I am a proud autistic father of beautiful autistic children. I am a devoted autistic husband. I am Chris Williams, an exquisite, autistic human being, one with his eyes on horizons of advocacy, of leadership, and of making a difference for my family and for others. It’s a good place to be.

So on that note, happy anniversary. Here’s a toast to finding myself, and to all old friends and new friends alike. Thank you.

Chris Williams. Photo courtesy the author.
[image: A solar-flare selfie of the author, a smiling white man with short dark hair,
wearing a red baseball cap with two giant cartoon eyes on it.]

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Editor's note: While many people find comfort in an official autism diagnosis, getting one is not always affordable or accessible, plus the Autistic community generally welcomes people who are self-diagnosed.

If you are newly diagnosed with autism, think you might be autistic, and/or are the parent of an autistic child, we recommend the following books and resources:

• Welcome to the Autistic Community! from Autistic Self Advocacy Network
• Loud Hands: Autistic People Speaking, edited by Julia Bascom
• All the Weight of Our Dreams: On Living Racialized Autism, edited by Lydia Brown,‎ E. Ashkenazy, and‎ Morénike Giwa Onaiwu
• What Every Autistic Girl Wishes Her Parents Knew, from Autism Women's Network
• How We Autistics Got to Here: Reviewing Steve Silberman's NeuroTribes by Patricia George 
• Nerdy, Shy, and Socially Inappropriate by Cynthia Kim
• I Think I Might Be Autistic: A Guide to Autism Spectrum Disorder Diagnosis and Self-Discovery for Adults by Cynthia Kim
• Shift Journal

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A version of this article was originally published on January 8th, 2018, at Medium.

*The children's names are pseudonyms.

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