Sunday, February 13, 2011

A Little Bit of Compassion 12

The Compassionate Mind

Malahide, April, 2010
Drs Anthony Storr, Ronald Laing and Ivor Browne have always and continue to appeal to me for their sheer compassion.  Ronnie Laing, especially, listened to, cared for and did not write off his psychotic patients as mad.  They struck and still strike me as compassionate persons.  Their written material is suffused with compassion I believe.  These are great psychiatrists and great healers as a result.  I suppose Freud and Jung were so, too, but they were more concerned with getting the theoretical base of their respective therapies systematized and scientifically based.  As I grow older I am aware that if we pare down the motivations behind great doctors and great humanitarians to the bare essentials we arrive at the base line of compassion for fellow beings, or sentient creatures as the Dalai Lama is prone to calling us and our fellow creatures.  As a teacher, while I acknowledge that the drive to knowledge for practical purposes and for its own sake are two important motivations for those of us in the profession, that the desire to help others in this more compassionate sense is also at play as well.

Empathy:

Having studied psychotherapy for a number of years I, like many others, have been attracted to the humanistic school of therapy as outlined in the person-centered approach of Carl Ransom Rogers.  This approach to therapy highlights the concepts of (i) congruence, (ii) empathy and (iii) unconditional positive regard.  These means respectively that the counsellor or therapist is (i) a totally authentic human being who has faced and has dealt or is dealing with his/her own problems,  (ii) is imaginatively able to put himself or herself in the shoes of the patient or client and (iii) that he/she unconditionally accepts the client without prejudices, and no matter who the client is or what he/she is supposed to have done or not done, the counsellor in no way allows such information to colour or effect their regard of the client; in other words the counsellor or therapist shows his/her regard for the client totally unconditionally.  I also like the fact that Rogers took the revolutionary step of recording his sessions and opened up the previously private domain of therapy for empirical study and assessment.

The Autistic Spectrum

Malahide, April, 2010
I am a teacher in a unit for pupils with Asperger's Syndrome, and I teach young adults from 12 to 18/19 years of age.  There are some 18 boys (they are all boys in our unit) and they lie along a very broad spectrum from slightly autistic to very much more so.  They all, bar three or four, present with a good number of other comorbid complaints like Dyslexia, ADHD, OCD, ADD, ODD etc.  However, they all share what we call the Triad of Impairments, i.e., Communication, Social and Imaginative.  The first of these refers to the late development, or even absence in some more serious cases, in verbal communication, echolalia (repeating words spoken to them) and literalism.  The second refers to problems of being lost in their own world, behaving as if others do not exist, their not knowing how to initiate or even continue a conversation, inability to read the spectrum of emotions on people's faces, poor eye contact and finally they may shake hands too limply or too hard even and can be excessively formal (quite common in my own group of pupils.)  However, it is the third of the triad that I am interested in here as it relates to the Imagination.

The Impairment in the Imagination

The experts tell us, and I know from both my professional training and day-to-day experience that a child with autism will (i) be unable to play imaginatively with objects or toys with other children or adults; that they
(ii) tend to focus on minor or trivial things around them, for example an ear-ring rather than the person wearing it, or a wheel instead of the whole toy train (iii)  have a limited range of imaginative activities, possibly copied and pursued rigidly and repetitively, (iv) often miss the point of pursuits that involve words, e.g. social conversation and literature especially fiction and subtle verbal humour. Linked in with these, then there will be a failure to catch the subtleties of play which a neuro-typical child will be able to grasp quite readily.  They won't be able to pick up the jokes and innuendos of the "tippies" in the classroom, for example and often I am left explaining the jokes to them after class.

Linked in with this failure in imagination is, of course, a failure of empathy.  The Asperger boy can and does fail to see things from the other person's point of view.  I remember when I was doing my psychotherapy training one of our lecturers telling us that empathy was an exercise in imagination.  Now, this definition makes perfect sense to me now that I am a fully trained Resource and Learning Support teacher as well.  Because our boys have a lack in the imagination department, they will fail to show empathy. 

Therefore, the lack of imaginative play leads to limited or, in extreme cases, no understanding of other people's emotions, so people with autism find it difficult to share happiness or sorrow with others. Many people with autism find their pleasure in special interests.  The special interests in our group range from Egyptology, Lists of Music Groups and Charts, with positions in the charts of all groups exact to the smallest detail, Black Holes, Leonardo da Vinci, Airplanes and so on and so forth.

Also I note that the following may be placed under this lack of imagination vertex of the triangle of impairments namely complex repetitive stereotypical behavior which may include (i) A complex sequence of body movements. (ii) Placing objects in long lines that can't be moved. (iii) Extensive bedtime routines, (iv) Attachments to strange objects, such as pieces of string or leaves and (v)in more able autistic people, fascination with the weather, timetables, numbers, etc.  One of our cleverer first years keeps taking my Fifth Year Maths book and placing it on the shelf in a fellow teacher's room who has the previous four books in the series on her shelves.  Josh simply likes placing Book number 5 along side its partners in crime, 1, 2, 3 and 4.  It took me a few weeks to find out what was happening to my disappearing book.  We both laughed when I found out!

Now, as the title of this piece is about compassion, I believe that understanding this failure in imagination (genetic no doubt) on the part of my students can and does mean that I can be more compassionate towards them.  Also yesterday I attended an amazingly good in-service on the topic "Using Drama with Children and Young People with Asperger's Syndrome," presented by Dr Carmel O'Sullivan of TCD Education Department. (See her web page here:   COSTCD ) Dr O'Sullivan has successfully used educational drama as an experiential approach to social skills education for young people in the age range 6-20 years with this syndrome.  This successful teaching and learning approach has been developed with over 70 participants during tha last six years as part of a collaborative research project with ASPIRE (Asperger Association of Ireland) (See their web page here:  ASPIREIRELAND.

Dr. O'Sullivan's presentation was excellent to say the least.  I also liked her definition of the imaginative disability which described above as being in essence a Lack of Flexibility of Thought.  She informed us that the aetiology of this impairment is located in that part of the brain called the amygdala.  She could reach the pupils and they one another through the medium of drama where she was able to bring them into a fantasy world and then back to the real world where they could apply the social skills they had used in performing their various roles in the drama which itself necessitated physical movement and, of course bodily contact, all of which such persons are very poor at. 

However, change and improvement in social skills is possible, but obviously slow enough with persons on the ASD spectrum.  However, where the person is situated on this spectrum is, of course, a deciding factor in the amelioration of the disability and in the learning of more complex social skills.  However, the important point for the teacher, and even more so, for the parent, is that change is POSSIBLE!  Then, let's also remember the topic with which I am essentially concerned, the growth in compassion for these persons is essentiaql to what we are about.  The IQ, as well as the EQ (Emotional Intelligence) falls along the whole spectrum with these pupils.  After 30 years as a teacher I have learned a lot of psychology practical as well as theoretic, but the most essential point is that one size does not fit all - everyone is unique.  While some generalizations are important from a theoretical point of view one has to be always open to the uniqueness of the individual.  This sharpens the edge of the theories we have all learned, if not blunting them at times!

In all of what our lecturer taught us - experientially I must add - she emphasized never imposing one's own agenda, and this went as far as never censoring their expressed thoughts and/or language unless more obviously not age-appropriate etc.  All of this appealed to me as I am a deep believer in self-expression, creativity in all its various incarnations, and also because, once again, it is an extremely compassionate approach to life.  I return to my three Doctors and therapists mentioned above, a triad of wonderful and beautiful human beings whose compassion led them into psychiatry and therapy and into listening to persons who had been written off by society at large - schizophrenics, bipolar people, other psychotics, and, of course, the autistic.  After all, it was, from my interest in schizophrenia, I learnt that the great Dr Bleuler (1857 – 1939), one of Jung's early professors, invented the term "autism" in the first place long before Kanner (1894 –1981) and Asperger  (1906 –  1980)  came on the scene in the middle years of the Twentieth century.  Bleuler was a Swiss psychiatrist and he introduced the term autism in 1911. Autism and autistic stem from the Greek word "autos," meaning self. The term autism originally referred to a basic disturbance in schizophrenia, in short, an extreme withdrawal of oneself from the fabric of social life, but not excluding oneself.  Obviously Kanner and Asperger went on to refine and particularize this term and other related ones in their more specific work on autistic persons.  Interestingly Kanner was Austrian-American while the other three were Swiss (Bleuler, Jung and Asperger.)

Two Types of Rumination

Returning now to the topic at hand namely the book The Compassionate Mind by Professor Paul Gilbert, I wish to refer to the idea of rumination.  Now all that I discussed above is ad rem as regards the question of compassion, and I mean here both compassion for oneself and the compassion for others.  Gilbert points out that because we can imagine, we can also ruminate.  He is quick to point out that there are two different types of rumination a healthy, positive more philosophical one and an unhealthy, negative, life-denying one.  The first, then, is related to trying to solve problems, and I would argue lose oneself in the magic of the mysteries of science, maths, art or any area of knowledge or human endeavour.  This first is also what we mean by the process of discovery in life, the ability to solve puzzles and to be enriched by so solving them.  They lead to what a former lecturer of mine, Michael Paul Gallagher used called the "Ahhh!" moments of life.  He was quoting some philosopher or other whose name I've quite forgotten now.

However, there is another form of rumination, an unhealthy, dark, negative and light-denying one also.  Here is where we are upset by someone or something and we replay again and again in our minds what has upset us.  An obvious example of this is where someone we love dies.  It also happens when someone bullies us or treats us unfairly.  We find ourselves going over and over it in our minds.

However, it is the role of the therapist, the doctor and indeed the teacher to help his client, patient or pupil to dispel the second type of rumination and replace it with the former if s/he can.  This is no easy task.  That's where drama, visualization, imagination and its legions of creative ways come in.  

To be continued. 

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