The boys’ mothers were trained to use the technique, called Soles of the Feet (SoF), 1 month before the beginning of baseline. For the first 5 days of the intervention, the researchers reported, each mother taught her son to use the procedure in daily 15-minute sessions. In some cases, the patients remained aggression free for 4 years.
In the SoF meditation, which is very concrete, the participant with severe mental limitations follows a series of steps that essentially wipe out his feelings of aggression. The person meditating is asked to divert attention from an emotionally arousing thought, event, or situation to a neutral part of the body. The individual is able to stop, focus his mind on his body, calm down, be in the present moment, and then make an informed choice about how to react to the thought, event, or situation that has triggered an arousal response.
I found the description of the SoF meditation interesting therapeutically, because the strategy builds on the idea that the Asperger’s syndrome patient has the ability to make choices. This technique also seems like a refinement of ideas advanced by my good friend Aaron (Tim) Beck, developer of cognitive-behavioral therapy (CBT).
These studies raise numerous questions for those of us in psychiatry. We are seeing a remarkable growth in the number of children diagnosed with Asperger’s syndrome, and it is now estimated that 10,000 children have autism and/or Asperger’s. This is a significant number. We know that there has been an expediential growth in the number of children diagnosed with autism, and I suspect we will see more Asperger’s syndrome as time goes by. We also should expect to find a great many adults with Asperger’s syndrome who have suffered with it their entire lives. That means that we can no longer make an assessment of mental retardation in every patient who lacks social skills. Asperger’s syndrome patients have the capacity to reason, learn, and think. However, we are woefully ignorant of their cognitive capabilities and skills. Finally, psychiatrists and other physicians have to learn more about autism and Asperger’s syndrome in order to keep up with the times.
The Virginia case raises several questions for us about the criminal justice system and how it responds to people with behaviors that are not understood. We’ll never know what exactly happened that day in Stafford County. But we do know that one of the problems with illnesses related to autism is that "even innocent behaviors can come off as malicious" ("Is Sitting While Autistic a Crime?" Newsweek, July 8, 2010). Cynics like to say that the largest mental hospital in America is the Los Angeles County Jail, where the cost of incarceration is close to $40,000 per patient. We have to get those in need of mental health care who are housed in our jails into treatment settings, where they can get the attention and medication that they need.
As humanists and caring physicians, we in psychiatry must educate the public about how mental illness works. This tragic case is a good example of our failure to do so in the law-enforcement community. We have to protect those whose conditions make it either tough or impossible for them to protect themselves.