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Book Review: Switched On


Book Review:

John Elder Robison, Switched On

Robert B. Waltz

Note: all opinions are of the author and do not represent the views of AuSM

The subtitle of this book is "a memoir of brain change and emotional awakening," but if you want an informal description, a better one might be, "Hey, lookee what I found!" It is the story of a well-known autism advocate whose life took a dramatic turn.

This is going to be a long review, so if you just want a quick idea of what the volume is like, let's start with a "good, bad, and ugly".





Book Review:


John Elder Robison, Switched On


Robert B. Waltz


The subtitle of this book is "a memoir of brain change and emotional awakening," but if you want an informal description, a better one might be, "Hey, lookee what I found!" It is the story of a well-known autism advocate whose life took a dramatic turn.


This is going to be a long review, so if you just want a quick idea of what the volume is like, let's start with a "good, bad, and ugly".


The Good:

  • A discussion of an intriguing medical possibility for dealing with some of the social deficits of autism
  • Written in good style by an author whose previous writings have been very popular; as a memoir, it has genuine merit

The Bad:

  • The so-called "science" was abominably badly done, meaning that the results prove nothing
  • Although Robison sees major effects on his life, it appears few of the other participants experienced such dramatic or positive change. Plus, many of us with autism can learn those abilities in social skills classes, or even on our own -- if we try

The Ugly:

  • Robison's experience caused him to more clearly perceive his then-wife's depression, so he walked out on her. As one who considers loyalty a virtue, I find this inexcusable. (Actually, I think it worse than inexcusable, but I can't say what I think of it in a family blog.)

John Elder Robison, the author of Look Me in the Eye, one of the most widely-known of all autism memoirs, became famous as a result of his book. That led to all sorts of opportunities and offers; he is on a lot of scientific panels that he frankly shouldn't be serving on. One of the offers was the one he describes in this book -- a neurological intervention to reduce the effects of his autism and make him a more social person. I know, we've heard of these tricks before -- but, this time, the technique involved is known from other studies to have clinical value in dealing with mental illness. It is called transcranial magnetic stimulation (TMS), and it has been used for depression for decades, and even been used in some experiments on improving brain function -- but not, until now, for autism.

Unfortunately, Robison -- who is not a scientist; he's a car mechanic with a knack for electronics -- went into the experience blindly. He understood parts of the process and treated the rest as a black box. He didn't even do his homework on science and scientific history. For instance, we are told on page 133 that Michael Faraday had discovered that electrical stimulation could make frogs' legs contract. No, he didn't; Luigi Galvani had discovered that in the 1770s or 1780s, publishing in 1791, the year Faraday was born. Robison's attitude made me very afraid that he would go into the experiment expecting a dramatic improvement, whether anything actually changed for him or not.

Some of Robison's comments make me think that the scientists he was working with didn't know much about autism either -- e.g. they didn't know that people with autism often have unusually acute senses (p. 60). And yet they were experimenting on autistics? And how could they conduct a psychological experiment and not have the patient keep a journal? The team that organized this study clearly needed to bring in an ethicist, a statistician, and someone who knew something about autism.

And they started enrolling subjects who had learned about their study via Robison's blog! Bad enough that they added subjects as they went along, but worse that they added self-selecting subjects. So they have a biased sample of people who, first, expected something because of what Robison was saying, and, second, liked reading Robison!

Oh, and what sort of blitheringly overconfident idiot undergoes an experimental brain procedure and then drives his own car home? For that matter, what sort of neurologists let him do it?

And the researchers kept giving Robison tips and ideas. Which adds even more bias. Why not hypnotize him and tell him what results they want him to achieve first? If they had deliberately set out to fake their results, they could hardly have chosen more effective techniques.

Despite all these caveats, I do not hesitate to say that Robison did change. On page 173, he finally realizes how nasty he has been to others. He started to learn how to do better. He became much more sympathetic toward others. He even started to look people in the eyes.

Of course, he could have just taken a social skills class... it really does seem as if he'd been allowed to be feral too long. And he still makes mistakes.

As I read it, he went into the lab expecting magic -- and so he got it. He made the statement that he had "always been as logical as Mr. Spock." By which he does not mean logical; he means unemotional. But he wasn't unemotional -- he has clear likes and dislikes, such as vicious practical jokes and excessively large-engined cars. It's not that he lacked emotion; it's that he lacked insight into his feelings -- and then, briefly, during the TMS session, he started had an insightful moment.

This isn't really surprising. TMS will start the synapses firing; of course you're going to experience some change in emotions. But other TMS subjects report only a short-term effect. Robison reported a long-term change. Was his brain changed, or did he just start using it differently? I'm a lot more socially functional than I used to be. Because I learned -- slowly and painfully, but I learned. Because I wanted to. Robison could also have learned many skills over the years, and simply not believed he had them or bothered using them. The claim of this book is that Robison developed greater ability to read emotions as a result of a magic treatment. Treatment -- or placebo effect? Based on what I read, I don't know.

Let me explain by analogy what could have happened. Suppose you walk into a dark room. You don't know where anything is, so you move very hesitantly around the room for fear of bumping into something. Then, for a few seconds, someone turns on the light. You look around and see the locations of the furniture. Now, even when the light goes off, you'll move around more confidently than before, because now you know where the furniture is. TMS didn't change Robison's brain permanently -- based on other studies, it can't do that. But it lit up his brain for long enough for him to use the emotional capabilities he had developed but wasn't using. (This would explain why the experimenters found greater effects in older patients -- they had more experience.) This is what happens when you conduct lousy experiments: You get non-meaningful results.

In the end, there are two possible reasons to read this book -- as a memoir, or as a scientific chronicle. As a memoir -- well, if you like John Elder Robison, you'll probably like to read more of him. If you don't -- then you won't. In some ways, I liked John Elder Robison better than I had before -- but on the whole I liked him less. That's because I think loyalty so important; I cannot manage to have any sympathy for a man who trashes his wife because she's depressive.

And the so-called scientists made me ashamed. This book fails as a description of neuroscience, partly because Robison isn't a scientist but mostly because the science itself is bad. In numerous ways. The sample is too small. It is self-selecting, with a strong bias. There is no control group. The researchers had no proper testing protocol (e.g., in the first round, no test of ability to read photos of emotions before and after). Once, they even changed the nature of one of their tests because Robison complained about it. This is not science.

Also, consider this: Although we call autism a single condition, brain scans of people with autism show tremendously different results. It may be one diagnosis, but it isn't one set of differences from neurotypicals.When I read Robison's first book Look Me in the Eye, I found very little of me in Robison; I really doubt that I am an autistic person "like him." Would a treatment that works on him work on me? Or on you? I wouldn't bet on it. To use one of my favorite quotes about statistics, "the plural of 'anecdote' is not 'data.'" And this book is all anecdote. "Extraordinary claims require extraordinary evidence."

Someone asked me if this is pseudo-science. Not quite; it's not good science, but it doesn't fall to the level of fakery. There are strong indications that TMS works for depression and has other effects. It did cause Robison to change. It's just that the research was so badly done that we can't know what role the TMS actually played.

For the moment, though, let's assume TMS works. That leaves an interesting ethical question that Robison hardly touched. We sometimes debate if it would be a good thing to "cure" autistic people if it means destroying their special autistic abilities. This is, I suppose, something to be answered on a case-by-case basis. But now consider this: Suppose we could cure an autistic person without destroying the autistic abilities? Suppose we could have an Einstein who was still Einstein but wasn't an asocial philandering jerk, an Isaac Newton who was still Newton but didn't steal credit from his rivals. Does that sound good? OK, flip it around: Now, suddenly, if everyone with autism has the strengths of neurotypicals and their own strengths, will we suddenly have neurotypicals demanding to be made autistic? Are we ready to face this question? Or suppose we can improve one ability per person, out of the list of known savant skills (calendar calculation, music, arithmetic, spatial, visual art). How do we decide who gets which augmentation? The world doesn't really need a half a billion new brilliant painters.

If you want answers, try another book. If you want interesting questions, this one might be for you.