Wednesday, October 24, 2007

A Small Voice in the Chamber

Tyler Durden: [pointing at an emergency instruction manual on a plane] You know why they put oxygen masks on planes?

Narrator: So you can breath.

Tyler Durden: Oxygen gets you high. In a catastrophic emergency, you're taking giant panicked breaths. Suddenly you become euphoric, docile. You accept your fate. It's all right here. Emergency water landing - 600 miles an hour. Blank faces, calm as Hindu cows.

Narrator: That's, um... That's an interesting theory.

Hyperbaric Oxygen Treatment (HBOT) has been called a treatment looking for a disease. Oxygen bars in the 1990s and Rick Moranis in Spaceballs were the first two things that came to my mind when told of the treatment. Despite all cultural baggage, HBOT advocates are fighting for a legitimate role in the therapy, especially in the increasingly large world of autism.

HBOT is the administration of oxygen at high density. Hyperbaric, meaning “high pressurized,” oxygen is either administered in a ventilation unit attached to the face or by lying in an large chamber. In a normal setting, an individual breathes only roughly 20% oxygen and 80% nitrogen. In HBOT, the patient either dons the mask or enters the chamber and, for a period of time, breathes 100% oxygen.

What does HBOT actually do? Here’s where the controversy arises. Many people disagree over whether HBOT is practical for long-term therapy outside of emergency care. For example, there is a strong contingent of people who believe HBOT works synergistically with behavioral and educational therapy to improve the language and social development of a children diagnosed with Autism Spectrum Disorder. On the other hand, other people simply believe since there is no scientific, evidence-based clinical trials proving the long-term benefits, HBOT cannot be promoted as providing said benefits. I belong to the latter camp.

HBOT is used in situations concerning decompression sickness (“the bends”), wounds healing improperly due to diabetes or other factors, carbon-monoxide poisioning and brain damage as a result of lack of oxygen. All these ailments share a bond in, one way or another, they work to refurbish depleted blood cells and blood plasma and fix ensuing problems stemming from said deficiency. For this, HBOT, beyond a measure of a doubt, works.

However, HBOT is now being forwarded as a possible treatment for autism. I believe HBOT does not work to help autism, but merely works as an opiate, to calm children down. In this tranquilized state, it is understandable many children can possibly develop greater language skills or be taught to obey in a classroom.

This application of HBOT goes beyond strictly physiological ailments, in the sense of decompression sickness or carbon monoxide poisioning, and attempts to effect behavior. In the same sense, stimulants such as Adderall, along with antidepressants and antipsychotic medications, have been proven to modify children with ASD’s behavior and have them function better in the classroom. Both approaches put children in a state of mind ready to receive behavioral instruction in order to advance themselves socially.

To be fair, advocates of HBOT might bristle if included with medicinal therapies such as Adderrall. HBOT is seen by its proponents as a so-called alternative medicine; it is not proven scientifically to work nor is it accepted in mainstream medicine, however some people believe it works.

But works to do what? An article concerning oxygen bars issued by the FDA says, “Oxygen fans tout the benefits of oxygen as reducing stress, increasing energy and alertness, lessening the effects of hangovers, headaches, and sinus problems, and generally relaxing the body” (source). Oxygen is equivalent to another great hangover cure: two painkillers and a glass of water.

Many supporters of HBOT for autism believe in the works of Bernard Rimland. Rimland is part of the population who believes MMR vaccines containing a mercury preservative cause the onset of autism in children. According to Wikipedia, Rimland’s contribution to autism scholarship came with his proposal of autism as a neurological disorder. This, over time, trumped the prevailing theory of so-called “refrigerator mothers” and set a more biological direction for autism research.

I disagree with the idea that autism is a neurological disorder. Neurological disorders such as Alzheimer’s, infections of the brain or brain tumors all have obvious physiological bases. As in, we can locate a deficiency or foreign agent that makes the brain act funny. To claim autism is a neurological disorder, then, is to claim it can be cured. As we have seen, long-term HBOT is not a cure but, at best, a sedative.

Is it wrong to use sedatives or stimulates to teach behavior? I believe that is debateable. I believe in our society the human body craves sedatives and stimulates. A recent NYT’s article called “A Two-Cigarette Society” mentioned how teens start smoking to emulate their peers, but continue smoking as adults because of the addictive properties. When someone is stressed, depressed or feeling insecure, a cigarette buzz can sedate them. We are also a sleep-deprived society, as another Times’ article points out. This leads to our overconsumption of caffeine, nicotine and a $4.5 billion dollar market for sleep medications.

An embarrassingly large portion of our population is either stimulated or sedated by drugs consumed outside the body. HBOT is another one of these opiates used by another segment of our population to make life easier. So rather than seeing HBOT as part of a meaningful “cure” for autism, we need to see it as a reflection of our greater society.

When asked in 1971 about what he perceived as the most impressive display of madness in contemporary society, Michel Foucault replied:

“I don't think that one can, except as a metaphor or a game, validly say that our society is schizophrenic or paranoid, unless one gives these words a non-psychiatric meaning. But if you were to push me to an extreme, I would say that our society has been afflicted by a disease, a very curious, a very paradoxical disease, for which we haven't yet found a name; and this mental disease has a very curious symptom, which is that the symptom itself brought the mental disease into being. There you have it.”


Thomas said...


I am impressed by the ambitious arc of this post and the
graceful moves made from the specific critique of HBOT into the
more abstract questions of medicinal (both those medicallt
prescribed and self-medicated from, say, a Diet Coke).

I'm a little miffed by your dismissal of autism as a
neurological disorder. From a structural standpoint, as I see it,
that paragraph serves as the conduit between the categorical
ideas of the beginning and the more contingent in the end. There
is well-disseminated documentation that expounds upon the
abnormal development of the brain itself (not just the
behaviors)in autistic patients. As with Alzheimer's and cancer,
there is no more established rhyme or reason to the underlying cause of these diseases. Maybe it's just semantics that I'm
hemming and hawing about. "Neurological" can be defined as "having to do with the functions of the brain" and autism
certainly falls under that categorization.

Anywho, I guess I'm looking for a bit more explanation on that
fifth to last paragraph (the one that introduces the idea that
autism is not a neurological disorder).

Coogan said...

Here's what I meant to say with the reference to autism not being a
"neurological" problem. You're absolutely right to say the term
functions very effectively as a structural reference point to
understand the problem. I wholeheartedly support the diagnosis of a
"neurological" issue to help people understand the condition.

However, what I don't support is the term "neurological disorder."
The term, forwarded under the controversial academic Bernard
Rimland, implies there is an empirical problem that can be "fixed."
For example, technically you could "fix" down syndrome if we knew
how to alter the chromosome in question.

"Neurological disorder" for me implies a researcher's goal in
studying in autism is to find the "silver bullet" that will "cure"
the individual. The reason why this bothers me is because autism is
not a silver bullet situation. Much of the research points to autism
as a network condition, with many elements (environmental,
neurological, physiological, behavioral, situational) coming into a
powerful confluence.

I refute the claim of autism strictly being a neurological condition
mainly because I believe in the network effect, with more fault
lying in society than the individual. Hence the last quote by
Foucault in the piece--more than anything else, society effectively
promotes and causes autism through the infusion of heavy metals in
the environment, the behavioral class of our political economy and
industrial uniformity of our everyday life.

trozz said...

A minor follow-up point:

Just wanted to clarify that stating that autism is a "neurological disorder" does not imply that it is something that can be "fixed"...if only it were the case with autism (clearly a disorder of central nervous system function, hense neurologic disorder) and so many other unfortunate neurologic disorders such as Lou Gehrig's Disease (spinal muscular atrophy) and Parkinson's Disease.

Bernard Rimland was not the first to dispell the myth that autism was caused by "refrigerator mothers" (though Darryl Laurrent made the same claim in a recent article in the venerable News and Advance).

Also--we do not have any scientific evidence that autism is promoted by an infusion of heavy metals, although environmental exposure to heavy metals as a possible trigger of autistis symptoms in genetically vulnerable children is being carefully studied under funding from the NIH.

All these points, though, are off the main topic of HBOT, whhich was excellently presented in the posting!!