Thinking in Pictures: My Life with Autism

by Temple Grandin

Vintage 2010

(note: this review might also serve as a review of Grandin's The Way I See It: A Personal Look at Autism and Asperger's. I've been looking through that book and have found much of it is identical or very similar to Thinking in Pictures.)

When Temple Grandin (b. 1947) was a young child she didn't speak, she didn't like to be touched, and she wouldn't make eye contact. A doctor told her mother that Temple should be institutionalized. Her mother kept her out of institutions, hired a speech therapist and a nanny, sent her to various special schools, got her through high school and off to college. Grandin went to graduate school, became interested in cattle, caring for them and preparing them for the slaughterhouse, began writing articles about cattle facilities, and eventually earned a Ph.D. in animal science. Today, one-third of the cattle and hogs raised in the United States are handled in facilities Temple Grandin designed.

Reading her story makes it easy to understand why so many parents of children diagnosed on the autism spectrum are skeptical of the advice and prognoses of doctors. In the 1950s, Grandin would have been labeled mentally retarded, brain damaged, or schizophrenic by many experts. (A Google Ngram viewer analysis shows "autistic" passing "mentally retarded" and "brain damage" in usage around 1993.) She says herself that if she had been diagnosed at the age of two by today's standards, she would have been labeled "autistic." She showed what she calls "the symptoms of classic autism: no speech, poor eye contact, tantrums, appearance of deafness, no interest in people, and constant staring off into space." Today, many experts would label her as having Asperger syndrome and being "high functioning." She advises us not to get hung up on labels, which is a good thing because in her case there really is no label that could do her justice; she is that unique. Also, there are nearly as many variations of neurological dysfunction as there are people diagnosed with a neurological disorder. That is one reason the expression "autism spectrum disorder," while vague, is less misleading than "autism." Being on a spectrum implies that an individual will neither show the same symptoms nor be helped by the same treatment as another individual on the spectrum. It is also a fact that some on the spectrum have such severe disabilities that very little improvement over a lifetime can be expected, while at the other end of the spectrum there are very high-functioning individuals. When Grandin was born it would have been common for a physician to have assumed that there was no hope she would ever develop normally and that the best thing to do would be to warehouse her in an institution for life. The doctors would have been right about no hope for her to develop normally, but they would have been wrong to have assumed that she shouldn't be given every opportunity to develop whatever potential she might possess. Her mother wouldn't consider institutionalizing her and Grandin didn't develop normally. She developed, though, in ways nobody could have predicted. She has become renowned for her accomplishments.

One of the more difficult things about the kinds of disorders that are categorized as all belonging to ASD or autism spectrum disorder is that there are several distinct kinds of problems that must be addressed. Each of these problems involves different areas of the brain. Grandin identifies four major areas of functioning, all neurological in nature, as needing to be addressed: language/communication, social skills, sensory systems, and behavioral problems. These are all very complex areas and not only can a person be affected in one or more areas, each affected person can be affected differently. For example, many diagnosed with ASD have sensory problems. Some are very sensitive to touch. Others are very sensitive to sounds or pitches of sound. Some are sensitive to different colored light. Some are extremely sensitive to smells. Without going into too much detail, suffice it to say that it is almost as if each person with ASD has a unique disorder and requires treatment and training that is designed just for that person. I can understand why parents of children with ASD are willing to try just about anything in a desperate effort to help their children suffer less and develop more.

Grandin uses her own experience, the scientific literature, and many anecdotes she's collected at conferences and in talks with parents to suggest various specific things to do or avoid when raising a child with ASD. Her general principle is to focus more on developing strengths and less on trying to overcome deficits. Grandin's greatest strength, in her opinion, is her ability to think in pictures. She says she's never thought in words. Words conjure up images in her mind. When she taps into her memory, she describes going to her video library and pulling videos or still pictures from her memory banks. She edits and mixes images to design things in her mind. She apparently also has a photographic memory. She can look at a page and create an image of it in her mind, and then later recite it back word for word. She says that if being cured of her disorder meant that she would have to give up thinking in pictures, then she would rather stay as she is.

Not everyone on the autism spectrum thinks in pictures, but many do and not knowing this would be a major deficit for anyone trying to teach or treat such a person. In fact, my main takeaway from reading Grandin is that there is a great variety of neurological disorders that manifest in such an enormous array of different symptoms that one can only stand in amazement that anyone ever figures out what is the appropriate treatment and training for any particular individual. Of necessity, trial and error is an essential mode of diagnosis, prognosis, and prescription. Today, if you have the resources, you can have your child's brain scanned and have very sophisticated sensory and cognitive tests that were impossible when Grandin was young. Few would have either the chance experience with a cattle chute or the genius to envision the "squeeze machine" that Grandin invented for calming herself. And so many have had such bad experiences with the side effects of prescription drugs that it is understandable why many are skeptical of drug treatment. Grandin is not. She admits that she has been taking prescription drugs for many years and does not use her squeeze machine anymore. Her main caution is to avoid trying several drugs at once and to keep dosage to the minimum necessary for effectiveness.

One thing I found endearing about Grandin is that she always clearly separates speculation from fact and she does this with words, not pictures. Some readers may tire of reading 'could', 'may', 'might,' or even 'I speculate that' or 'this is pure speculation,' but I found these linguistic cues indicative of her scientific mind, a mind that knows the difference between what the evidence supports and what the evidence might one day support. For example, nobody knows what causes autism and Grandin doesn't pretend that she does either. It might dismay some readers to find that she doesn't dismiss those who are absolutely certain that vaccines cause autism. For those who want to find out more about that belief, she recommends reading Mark and David Geier and David Kirby's Evidence of Harm. She doesn't seem to favor this view, however. Her thinking is that the cause is genetic and that there is a cluster of interacting genes involved whose traits are expressed along a continuum. When several traits are expressed in the extremes, the hypothesis goes, you get disorders that range from mental retardation, to autism, to Asperger's syndrome, to mental illnesses such as schizophrenia, bipolar disorder, and obsessive-compulsive disorder. When only one or a few of the traits due to this cluster of genes is expressed in the extreme you get creative thinkers, adventurers, explorers, artists, and geniuses. Neurological disorders, according to this view, is the price our species pays for all the benefits that come to us from this cluster of genes. People afflicted with these disorders are, so to speak, collateral damage from the evolution of our species.

The genetic hypothesis doesn't preclude environmental factors from being triggers of neurodisorders. In addition to vaccines (for which there is overwhelming evidence against them being involved in causing ASDs), household cleaning agents, viruses (infecting either a pregnant mother or the affected child), and environmental pollutants such as heavy metals have been blamed. The truth is that we just don't know what causes ASDs. There may someday be a cure for some of these disorders, but those like Jenny McCarthy who claim they've cured their children of autism are deluding themselves.

Even if there weren't ethical issues that would prevent scientists from doing double-blind controlled experiments on children with ASD, there are so many variations of the disorder that the difficulty of controlling for relevant factors would preclude such studies from having much value. Observational studies offer more promise for finding the right training or medication for an individual, but even here the fact of so much variability precludes any simple answers. Grandin's advice for parents to try many things, keep using the ones that work, and reject the ones that don't seems reasonable given the variations just mentioned. Each afflicted child is like a difficult puzzle that has its own unique solution. Finding what works involves trying to make sense of what might appear to be irrational and senseless behavior, e.g., tantrums, staring off into space, rocking back and forth for hours, whirling and spinning, holding hands over ears, etc. I should note that Grandin is very much aware of the problem of post hoc reasoning and warns against jumping to conclusions just because one thing follows another. A change in diet may be followed by some noticeable improvement in behavior, for example, but the diet may not have been the cause of the change.

Most of Thinking in Pictures is either an account of Grandin's own special journey or advice for parents with children diagnosed with ASD. She concludes the book with a chapter presenting her views on religion. She was brought up as an Episcopalian, but she doesn't seem to be a member of any church or devotee of any particular religion. She thinks of "God" as an "ordering force" in the universe and she thinks of religions as providing moral guidance. She has some interesting comments about the relationship of prescription drugs and chemicals to religious thoughts and behavior. She mentions one person who is fanatical about religion unless she takes the antidepressant Anafranil (clomipramine), which makes her behavior more "moderate and reasonable." Grandin likes chaos theory because it means that order can come out of disorder and randomness. She used to believe in an afterlife and that if there were none there'd be no point in being virtuous, but she seems to have changed her mind about those ideas after reading about NDEs and experiencing the effects on her brain of chemical organophospates: the feeling of awe disappeared. Organophospates alter the level of the neurotransmitter acetylcholine in the brain. It made her wonder: were her feelings about God induced by a chemical Wizard of Oz in her brain? Then, she says, the possibility of a void after death motivates her to work hard and accomplish whatever she can in this life. Then, she discovered quantum mechanics and thinks that somehow that provides a basis for belief in a soul and the supernatural. Entanglement, she speculates, "might cause a kind of consciousness for the universe." True. Then again, there's no reason to believe it does. Grandin's current concept of God is of the entanglement of particles in the universe. I will only add that some great physicists who know more about quantum mechanics than the rest of can ever hope to don't find any religious solace there. On the other hand, some scientists agree with Grandin. This fact leads me to think that quantum mechanics doesn't imply anything particular about souls or the supernatural, but that believers find a way to accommodate the science to their beliefs. This is similar to the way believers and non-believers perceive the order and beauty of the universe: the believer sees the universe as implying the supernatural; the non-believer sees the universe as not implying anything beyond itself.

Grandin's speculations about entanglement might find favor with others equally ignorant of quantum physics such as Dean Radin. For example, she speculates that if she were to mistreat an animal, "an entangled subatomic particle could get me." How? It's mate might be in the steering linkage of her car and could cause it to break. Others might find her thinking "irrational," she says, but "to her logical mind it supplies an idea of justice and order to the world." It does, but why should we assume the universe cares about justice? When the volcanoes erupt, they kill good and bad alike. When the hurricanes smash a city and the tornadoes destroy the countryside, there is no justice in the damage they cause. Bad things happen to good people and good things happen to bad people. Some speculate that the desire to see justice done is the main motivation for believing in punishment and rewards after death. When I read the Stoics and Spinoza, I am filled with admiration for the idea that virtue is its own reward. When I read stories that say "do this or you'll suffer eternal torments," I am not inspired. And I think it is as pointless to speculate about subatomic particles being entangled to explain justice as it would be to try to understand neurological disorders in terms of entangled subatomic particles.

So, if you're looking for a good philosophy book, this is not the one for you. But if you're looking for a good book about ASD, Temple Grandin's Thinking in Pictures could prove rewarding.

I'll conclude by saying that I understand why the editor did not alter the order of Grandin's ideas, even though the book would have read more smoothly and less disjointedly had the editor intervened. But Grandin thinks in pictures and the associations she makes are the ones that should be presented, not the associations of the editor. However, Grandin's editor did her no favor by not removing some of the repetitious sections.

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Temple Grandin is a professor of animal sciences at Colorado State University. Her autism website has more information about her books, talks, and the film Temple Grandin that won seven Emmy awards.

I first heard of Grandin while reading An Anthropologist from Mars by Oliver Sacs, in which he examines several "differently brained" people.. Sacs wrote the foreword to Thinking in Pictures, which is posted below thanks to Amazon Kindle.