Too many autistic adults are denied basic rights

That is the topic of my latest Bloomberg column, here is one excerpt:

Some of the very worst treatment of the vulnerable is hardly being discussed. There is an entire category of American adults being denied almost all of their basic legal rights: to hold a job, choose a residence, determine their health care, enter into contracts and even decide what to do with their own body. These are adults under legal guardianship — a court-imposed process, in Ohio as elsewhere, “by which a person is relieved of the right to make personal life decisions and another is appointed to make those decisions on that person’s behalf.”

Among the adults who have lost such rights, or live under the fear that they will, are those with autism. It is entirely possible that they will end up in guarded and segregated communities, often against their will.

Perhaps you think many of these individuals are unable to care for themselves and therefore their full rights cannot be respected. To whatever extent that may be true, it is not a reason for trampling on human rights. And even if you believe it is, you must concede that the legal system is prone to horrible misjudgments and mistakes.

After recent revelations about institutional racism, it is hard to believe that prejudices do not affect decisions about guardianship. The justice system is already heavily biased in favor of plea bargains, in effect favoring efficiency over constitutional rights. And even when there is no bias, there is the reality of simple error — which are common enough in hospitals, where the stakes are much higher.

Definitely recommended, do read the whole thing.  And don’t forget this:

When it comes to guardianship, is there any reason to be so sure that liberty-protecting institutions are in place? Especially since basic information is so hard to come by? As both a people and a polity, Americans do not always behave best “when no one is watching.”

Overall it is remarkable to me how little good information, or for that matter argumentation, is available on this topic.


As the pandemic has shown, Americans do not always behave best when the world is watching.

+1 tiramisu of sophistry
nobody "always behaves best" whether or not in a pandemic or whether "the world is watching."
does anybody else think epstein was blackmailing/sextorting
the elite? and if so to what ends?

I remember these same arguments against mental hospitals. It didn't work out.

+1 non sequitar
isn't it plausible that epsteins creepiness was a means towards the end
of collecting intelligence or influencing public policy

A ffew oof these sites aso allow individual to end up gstting receiving bonuses while some don't.
Tonight on October 1, 2012 Shannon and Gene are finally
married. It sucks that she died because she any very entertaining person.

Excellent point Thiago.

Prior finally has a thread all about himself!

where in the world is Thiago?
he hasn't been seen since we asked him about his pronouns

I have no idea who wrote this top post, but I think it's interesting how many reply in a way "especially humorless and obnoxious and I would say neurotic" - just a few days after we talked about that kind of "cancel culture."

To take the line on for content, I think it has something to be acknowledged. Indeed, these days we look at the charts and take what solace we can that we aren't the *very* worst.

For example, I take that solace as a Californian. At the same time understanding the tragedy of it.

(Tyler's essay is good. More attention could be focused on the problems of guardianship, and perhaps the opportunities. For instance, how many homeless are unhappily independent?)

notta neurotic
its time to tell the shame cult to go pound sand
we gonna dance with a hurricane

Yikes, Americans are being closed out of many countries, but Cambodia(!) will still let us in if(!) we deposit $3K for healthcare—incl. $1,500 for funeral costs.

This is not something my 16 year old self could have possibly predicted. Cambodia imposing health standards on Americans.

that is not the definition of "health standard" by any stretch of the dictionary

Semantic escape valve?


after that since its a sunday
we gonna have pancakes

Autistic Lives Matter.
ALM, baby. Say it loud.
Incessant Social media yammering and jabbering ain't gonna do it.
Actions speak louder than words.
Meaningful actions. You need to do more than just "bend a knee."
Moral clarity, baby.

I want my reparations!

I think that's something that needs to change. It would make a difference to people's lives. I remember reading a New Yorker article a few years back " How the elderly lose their rights" about guardianship abuse and "professional" guardians who abuse the elderly and run guardianship mills in Sun CIty Nevada.
Similar story : loss of rights, little recourse. Unfortunately it's not a trendy cause.

recent revelations about institutional racism

Unless "recent" means something very different to you, I have no idea what you're referring to.


Yes, the obligatory knee-bending.

Yes, I wondered what the devil he was talking about. Then I realised it's just a defensive measure that need bear no relation to the world of facts at all.

In Cowen's defence, "institutional racism" is an idiom that is widely understood even if it imperfectly describes the phenomena being discussed. Given the context of the article, I think he is referring to the structural bias built into policing and the legal system that disproportionally impacts low-income communities. consistently reports on these institutional structural biases.

Let's not assume nefarious motivations are at play when much simpler explanations exist; naming things is hard.

could be referring to seatle where they have segregated! diversitiy
re-education and de-whiteness affirmations.
its a culty cult but it is also an elegant model of institutionalized racism

"Anti-Racism" has been defined to require placing significant weight to race when making decisions on such matters as hiring, promoting, admitting (etc.).

If you're not Anti-Racist then you are racist.

+1 postmodern bizarro sociologyland
apparently if you say all lives matter or you buy goya beans that
has also been defined as racist.

"Institutional racism" is not a "recent" term. It was coined in 1967, and even given a definition by the UK government in 1999. Reason also discussed it at the time. Which "revelations" are "recent"?

see Dr. Sowell discuss institutional racism here

No need to worry about what could possibly go wrong. We've done that already with schizophrenics and heroin addicts and things have have turned out just great!

Not to worry, the police shoot to kill unarmed autistic people, and hit those working for institutions caring for them, setting them free of institutions to live on the street, where the police can get more chances to shoot them.

And autistic people might be safer from police shootings if institutionalized.

a blm activist in indianapolis just murdered a somebody for saying
all lives matter
its a culty cult

Police do not seem to handle dealing with mentally ill persons well. With the result that calling for help in dealing with a threatening mentally ill relative may result in death, and presumably profound remorse for having made that call.

police deal with the mentally ill every day and death as a result of calling the police is an extremely rare outlier

Tyler, I am a long time reader of your blog and truly appreciate your insight into a wide variety of topics, however as the parent of an autistic son I feel inclined to offer a counter perspective to your viewpoint on guardianship. My son is physically 20 years old but mentally closer to 10. We applied and received approval to be his legal guardian shortly after he turned 18. This was not an easy process. The county sent investigators to our home and interviewed all of his teachers, doctors, and immediate as wells as extended family members. They were actively looking for reasons to deny our request. Additionally, even after receiving the approval to be his guardian, the county is required to visit our house unannounced at least once a year and interview him outside of our presence to reconfirm he is being treated fairly and that he wants to continue to live with us. I completely understand the work they have to put in before recommending someone’s rights be taken away. We did not enter into this guardianship lightly. Our long term goal is to have him living independently. Pre-COVID he had a part time job and was going to a job training class, however, mentally he is still very much behind his typical peers and we need to protect him while he completes his understanding of how to function in society (cook for yourself, avoid scams, pay bills, get to and from work, etc). The good part about autism is many individuals on the autism spectrum can live a long, productive life. The bad part about autism is it is such a wide spectrum. What works for my son might not work for your child. What seems easy for your child might be impossible for mine. This is where I have issues with your article. There are too many variations with autism to say the guardianship process is bad for everyone. Yes It is an intrusive process for all involved and Yes there are many parts of it that can be improved. Given, however, the stark difference in liabilities and responsibilities between someone who is under 18 vs over 18 regardless of their mental age we have found it to be beneficial to our son and our family.

Everyone over 18 has the absolute right to make all decisions for themselves. Anything else is slavery. No matter what the good intentions may be. This is guaranteed in the US Constitution. And it is a human right. Stop the lies about a person can’t decide for themselves. Mental illness used to control a person is a tool of the Soviets and Nazis.

Ever cared for someone who cannot speak, dress themselves, or feed themselves? Everybody who lives here as a resident does not have the absolute right to make all decisions for themselves -

Maybe you should volunteer there for a week, and find out that the residents are not living in slavery. And the Mennonites are generally not considered connected to Nazis or Soviets, except as being victims of both.

Habeas Corpus. Article 1. US constitution. And human rights. A person may voluntarily seek help from another. No person may take away another’s freedom to reject it. That is called slavery. And no. Mental illness is not an exception. The Nazis and Soviets used this to enslave people they did not like. And worse.

Impressive — every word in that post had nothing to do with the actual point that was raised, concerning those utterly unable to communicate their needs for anything, including help, at all.

Face the truth. Offer help. Leave the door unlocked. If help is rejected that’s the right of each person. Pu are locking the door through guardianship for your needs. Not the person who rejects your help. They may dimply not want help.

I'm with Mark Delp on this one. I also have an adult child with autism. He's non verbal, so can never clearly express himself. The process by which we were granted guardianship was extensive, and involved testimony by his teachers and health care workers, and then a hearing before a judge. I would guess that the vast majority of guardians of autistic adults are their parents, at least while they are alive. Tyler: do you really think that you know better than they do what is best for their child?

Mort, i agree with you. Being the parent of a special needs person is like being a member of a fraternity that you had no intention of joining but wouldn’t give it up for anything in the world.

I’ve read MR and followed TC here and through his books and articles elsewhere for many years. I’m an unabashed fan.

I’m sorry, Tyler. You raise reasonable concerns in your guardianship article, but you don’t seemed well-informed as to the reality on the ground for many parents of adult children with autism.

I weigh in to support Mark and Mort as yet another father of a mid-twenties son profoundly disabled. His diagnosis vacillated over his childhood from Asperger’s Syndrome and PDD-NOS, but settled eventually into the clear and convincing label of Autism. Although I did pursue official guardianship of him briefly when he was nineteen, I withdrew when I saw just how invasive the process would have been had I continued. His de facto circumstance though is one of protected, limited freedom, solely in his own best interest.

He lives well in a basement apartment of his own, under my mother’s home. But even without guardianship, he needs daily supports from various family members.

There is no chance he could live independently for more than a day or two. He does not drive, understand busses or trains, or have much adult-level sense for money, personal safety, navigation, appropriate social behavior in public, legal limits on his wants and desires, prudent shopping strategies, or personal responsibilities in a complex world. The contours of these problems are uniquely his, for as is true for all people with autism, his skills are wildly splintered — some adulting he performs better than I do, while sometimes he fails in efforts my preteen grandchildren can easily accomplish.

My son has adult siblings both older and younger than he, who are capable, neurotypical members of society. Their brother is different. You should not be assuming your policy prescriptions in these domains are somehow more just or correct than what we parents of these vulnerable adults provide on their behalf.

The highest risk of abuse is when you have elderly people put under the care of professional guardians. These "professionals" are often well-connected lawyers who get to pay themselves generous professional fees out of the assets of the person they are acting as guardian for. I think a lot of the abuses Tyler is worried about would be mitigated by due process -- which seems to have existed in your case -- and insisting that guardians be either blood relatives or civil servants paid directly by the state for their services. The idea of outsourcing a state function that is supposed to be for someone's "own good" and then authorizing the guardian to skim off of the protected person's assets is gross and leads to corruption.

"The highest risk of abuse is when you have elderly people put under the care of professional guardians. "
we gonna need to see the paperwork on that bold claim

And the New Yorker article already cited. Some states appear to lack even the most basic certification requirements for professional guardians. "To show just how lax states can be, GAO employees used two fictitious identities — one with bad credit and one with the Social Security number of a dead person — in four states, Illinois, Nevada, New York and North Carolina. All four granted the bogus applicants’ certification."

that doesn't confirm your assertion that the "highest risk of abuse is
when you have elderly people put under the care of professional guardians"
there is a lot of elder abuse of elders not under guardianship.
ex. two elderly people just got stabbed on the subway

Another problem with guardianship is the complete lack of transparency that exists in some states. Court proceedings and records of expenses claimed by guardians for their "services" are secret and wards can be isolated from friends or family members so they don't even have the ability to complain to the outside world. It seems that even Guantanamo detainees have more rights.

Your experience demonstrates something sorely lacking in Cowen's treatment of this subject: Each case is different because we are talking about individual human beings, not groups of persons lumped into sometimes arbitary classifications such as "autistic". I'm surprised that Cowen would succumb to the latter because, in my view, this is the very essence of unwarranted discrimination---that is, judging an individual human being not based on that person's specific qualities and circumstances, but by the category we lump him or her into (jews, blacks, hispanics, gays, etc., etc).

The very purpose of these often burdensome legal procedures is precisely so that the courts (usually a family court or probate court) can consider the specific circumstances of an individual and the prospective guardian. This allows courts and judges to be apprised of the facts necessary to make informed judgments in specific cases. To be sure, the system is not perfect and abuses of guardianship authority are too frequent despite the procedural protections built into guardianship laws; but, I much prefer that we treat each case individually as we now do rather than making blithe and relatively uniformed global judgements about how society should treat this problem or that and in particular, specific persons each of whom are human and devine. I'm glad that your son has a loving and caring father.

"Each case is different because we are talking about individual human beings, not groups of persons lumped into sometimes arbitary classification" That may be a hard point for some economists to grasp.

Thanks for sharing. I expect your experience is close to the median, and take Tyler to mean that we as a society should take care that it remains so.

And sadly there will be edge cases (I mention the unhappy homeless above) which will be difficult to judge in any circumstance.

"I expect your experience is close to the median, and take Tyler to mean that we as a society should take care that it remains so."

I question how you could come away with the conclusion in the second part of that sentence when Tyler condemns carte blanche the alleged maltreatment of an entire group of persons regardless of specific circumstances of each (or even any) of the individuals in that group: "There is an entire category of American adults being denied almost all of their basic legal rights".

And, this sweeping conclusion before writing: "Overall it is remarkable to me how little good information, or for that matter argumentation, is available on this topic." How does one draw such a broad and definitive conclusion despite lacking information and, I'm pretty sure, any practical experience? Tyler seems to be taking a very unusual take on what "legal rights" means. "Legal rights" include rights recognized by constitutions and laws, including the common law (courts in equity). It's hard to come up with a "legal right" that is truly absolute. Tyler's "legal right" to free speech doesn't mean that he can yell "fire" in a crowded theatre. A parent's "legal right" to custody of his or her children doesn't mean that if he or she tortures or abuses them that that "legal right" cannot be taken away. The law, as in the case of declaring an adult person "incompetent" and appointing a guardian for that person rightly deals with this tension by creating presumptions and burdens of proof---in this case, the presumption is that a person is competent and the strong burden is on the person claiming otherwise.

The common law of guardianship has been around for hundreds of years (longer than that if one includes Roman law). Is there a better way? Can existing law be improved? I don't find any informed or constructive suggestions in this post.

"I don't find any informed or constructive suggestions in this post."

To quote TC - Fix this now! And I mean you.

Mark, thank you for your excellent comment. A beautiful flower growing in well-fertilized soil.

I never can predict what people will mean by "autistic" anymore. 30 or 40 years ago, it seemed to imply nerdiness, but now it seems to be used largely as a euphemism for retarded.

Perhaps this was inevitable due to society exterminating most of the highly non-nerdy Down's Syndrome population that in the 1960s-1970s made up such a large fraction of the retarded. So now is autism used to mean retarded because there aren't many non-nerdy retarded people left?

In the early 2000s, it came to be common to use "Asperger's Syndrome" to imply what had previously been implied by autistic. But then that term got dropped from the DSM for reasons I can't remember, and now Asperger himself is being memoryholed for being a Nazi.

But it would be useful to have medical terms that imply nerdiness without necessarily implying retardation.

He is being ignored because he was a typical Nazi, a fact that some people prefer to ignore, along with his solution to the guardianship problem.
"In this issue of Molecular Autism, we publish an article by Herwig Czech, a historian of medicine at the Medical University of Vienna. His carefully researched article concludes that the pediatrician Hans Asperger, after whom the subgroup of Asperger syndrome was named, and who worked in the University of Vienna Pediatric Clinic during the Second World War, not only collaborated with the Nazis but actively contributed to the Nazi eugenics program by referring profoundly disabled children to the Am Spiegelgrund clinic located elsewhere in Vienna. This was a clinic that he knew participated in the Third Reich’s child euthanasia program, where children were killed as part of the Nazi goal of eugenically engineering a genetically “pure” society through “racial hygiene” and the elimination of lives deemed a “burden” and “not worthy of life.”

The actual article is People like Asperger, and other fans of race hygiene, should never be forgotten, regardless of whether it be their thinking or their actions. Evil not only requires the inaction of the good, it also requires people who are not even aware that it has a history in the first place.

there is beaucoup research on autism/asperbergers that was not done by

"I never can predict what people will mean by "autistic" anymore. 30 or 40 years ago, it seemed to imply nerdiness, but now it seems to be used largely as a euphemism for retarded."

If anything, I think it was the opposite - in the old days, "autism" was used to designate people totally incapable of having an independent life (see "Rain Man", a filme from 1988), and it was with the invention and the popularization of "asperger's syndrom" (largely in the 1980s-1990s) that the label becames to be applied to people that before were considered simply as "nerds", "loners" or "eccentrics"

The problem here is that autism is, IMO, merely a wastebin taxon that can include a variety of people from those that have a relative social deficit to those that are intellectually disabled.

E.g. one of the purest demonstrations of this sheer wastebin-ness I can think of is that TC linked an article a few weeks ago where an author claiming to be autistic claimed that most women with autism have actually enhanced social abilities (in direct contradiction to what the main diagnostic criteria for autism is!), but use a more cognitive approach to social behaviour than other women. A quite amazing feat of redefinition I think, to not only purely ignore the primary diagnostic criteria, but suggest people with the syndrome are those whose behavioural strengths phenotype are directly opposite to the syndrome's diagnostic criteria!

This "flexible definition" possibly relates to how the Progressive White Upper Middle Class suddenly discovered all their kids had about a million disabilities that meant they needed extra time on exams, as soon as they started competing with Asian kids.... ("My kid was secretly Steven Hawking and we never knew until now!").

Anyway, this makes it not very useful when talking about it as a category related to the capacity to exercise judgment in regards to these matters of "basic legal rights".

Some people who are "autistic" can't exercise judgment, some people "with autism" can. I would be quite suspicious of the notion that many people with autism who can clearly exercise judgment have been declared unfit to do so, though you might get a few borderliners.

Am I the only reader who finds it odd that Cowen would bring up the subject of autism now, in the middle of a pandemic and as researchers desperately try to develop a vaccine. Cowen must know that the anti-vaxxers blame vaccines for autism. Granted, Cowen is raising two very good issues, autism and guardianship, but just the same reading his essay alongside the many by Tabarrok on the development of a vaccine is jarring. I'm a lawyer and am familiar but no expert on guardianship, but the single most important lesson I've learned about guardianship is to avoid it. As for autism, I'm familiar with but no expert on that subject either. My nephew has two children, both autistic, and the nephew of one of my best friends is autistic, three autistic children I have spent much time with. My two comments are this: one, it's called autism spectrum disorder for good reason (see commenter Mark Delp), and two, the dangers to autistic children are basic, in particular the absence of fear that's common to most children, which makes them a high risk of flight (among other risks). The stories the parents tell, and the story I can tell from my experience, are frightful. Keep the doors locked may seem the simple solution, but just try to do it. But here's a good story: a couple in the low country where I once called home have an autistic adult. Absence of fear is still a problem (he can disappear into the night), but he is the sweetest most agreeable and least disruptive young adult I know. At a restaurant or at a party he can sit quietly, smiling, while playing a computer game for hours. He's a wonderful human being to be around, the ever-present smile making me wonder what he knows that I don't.

Sorry, Tyler. Your column is about the institution of legal guardianship. It's a very old institution and I assume that there are important differences across legal systems and political jurisdictions. I don't know how it works in the U.S. so I'm not going to comment on your concerns. I assume, however, there may be large differences across states because its effectiveness depends on how it's implemented which in turn depends on the funding of relevant state and local agencies. Please review comparative studies of children's guardianship across states.

I'm surprised at your last paragraph:
"Have you ever wondered how previous generations tolerated or even encouraged so much racism, prejudice, segregation, incarceration and other abuses of human rights? You don’t need a time machine to find out."
Yes, I have been wondering about that for the past 70 years, and I can tell you that today's systems are far from perfect as measured by any normative standard, but much better than previous ones. Today, in most countries, their coverage is at a historical record, but massification does not necessarily mean an increase in average quality (look at schools and universities). As a Public Choice scholar, you may know that the quality of all traditional government services (including some income redistribution) has been deteriorating to increase their scale and most importantly to increase the scope of government intervention (in particular, more income redistribution).

"You don’t need a time machine to find out."

On an absolute scale all social creatures are conservative, in the sense that they will *all* acquire and propagate *most* of what they learn.

The very few "revolutionaries" in society make their names demanding very little. "Eat plants." "Share stuff." It's all tweaks and hacks. Thus, the arc of the moral universe must be long.

A common problem in financial planning is the failure of person A to create a medical and financial power of attorney. In the event A becomes unable to handle their own affairs, person B who steps up to accept the burden for managing A's care and affairs has to go to court to have A declared incompetent, and a guardian appointed (usually B). The period of A's incompetence often lasts only a year or two, but be significantly longer.

Taking your no longer quite all there parent to court to have them declared incompetent is something to be avoided. If you have kids, do them a favor and get your paper work in order ahead of time.

With today's smaller families, an increasing number of people (statistically primarily women) will reach old age with no one they trust enough to give power of attorney. Based on the financial planning discussions I've seen, its a problem with no good solution.

Most people have no financials to plan, being reliant on government for all financial support.

Especially the autistic, retarded, disabled, handicapped, or whatever term is used to describe the young police treat with guns based on when your tool is a gun, all wards of the state are shot.

It's fine to present an opinion (guardianship is bad for people with autism) but you should also present evidence. As one of the posters above, noted, people are not put under guardianship without an extended process, because the rights of an adult should not be taken w/o strong reasons. The issue of whether some guardians are predatory is separate; in my state that cant' happen. I know two public guardians, and believe me, they are doing God's work. Usually, family members who are given guardianship are also. Adults with autism may simply be socially awkward, but most are also developmentally delayed, unaware of danger, and unable to maintain full employment. This topic deserves a better treatment.

Sorry, EB. I'm the EB that has been writing comments in this blog for a long time (on this post, I posted a comment today at 7.06 am). I live in Chile and I assume you live in the U.S. so from now on I will use the name EB-Ch.

I agree with you that the topic deserves better treatment.

Thanks, EB-ch. I've been posting for a long time too, but I guess our paths never crossed. The data are no doubt hard to assemble due to differing systems in each state, but targeting abusive guardianships should certainly be possible, while leaving the necessary ones alone.

What is Tyrone up to these days?

"... you must concede that the legal system is prone to horrible misjudgments and mistakes." TC

...that is true throughout the American legal system --- legal-guardianship (for any reason) is but a very trivial issue in face of the basic problem.

Tyler has somehow 'discovered' yet another Government-Failure.
One would think he could discern the broader issue involved ?

Note that this also opens the door to more ballot-harvesting and vote fraud, since an end to guardianship means all the mentally disabled will be able to vote. The SEIU member nurses will be happy to help them.

It may be one of the links in the Bloomberg piece, but just in case here’s Rachel Aviv’s New Yorker article from 2017: “How the Elderly Lose Their Rights: Guardians can sell the assets and control the lives of senior citizens without their consent—and reap a profit from it” -

My grandmother managed her younger brother's affairs almost her entire adult life. She claimed he was mentally challenged because he had a fever after drinking bad milk as a small child, but Grandmother was not immune to the sin of pride and she may have preferred this to a genetic explanation. It was clear to her, after the deaths of her own parents, that he would likely empty his bank account at a moment's notice to anyone who asked. She bought a property with a house, and built a simple spare dwelling on it also. She installed, patron-like, a Mexican-American family in the house, with the understanding that they would provide her brother, who lived in the bare-bones backhouse, a hot meal every day. She paid them to do this for about fifty years. In her will, she left the property to that family, of whom she was very fond, whose home it had been all that time. Her brother outlived her only a couple of years. I only met him once that I recall, though he was my uncle.

This system really gave him a lot of independence. Her guardianship was total, financially, but not heavy-handed. He saw his sister only a couple times a year, or even less when she was elderly. When she was dying, she made one last "Trip to Bountiful" to her hometown, closing out that long responsibility that she had handled with alacrity since she was a young wife and mother.

How she prevented her brother from fathering children I don't know, but maybe that was not an issue for some reason. He never enjoyed a romance that I'm aware of.

I should add that, unlike the fellow in rayward's Faux-lknerian telling above, this uncle was no idiot savant, just an ordinary mentally handicapped person. An effort *was* made, by his parents, to make him a "productive citizen" (why, even in that benighted era, they thought of that, imagine!): they got him a job at Phantom Ranch, wrangling horses, and he did that for awhile as a young man.

Its ... it's a difficult issue. Generally these people are put in this condition because of their disability giving them irrational fears or making it impossible for them to do things, but of course, by putting them under guardianship, you realize those fears.

Suppose someone has an irrational fear that someone is watching them, someone is going to take over, they constantly feel trapped and that someone is going to deny them choice. So you go to a psychiatrist, and diagnose the patient with paranoia / psychosis, and then put then under surveillance and guardianship.

Well, now it turns out they had a very good reason to feel the way they do. And explaining that to them is downright impossible. I'd imagine autism is similar. In other words, denying agency to someone often validates the very delusions you are using as the basis to deny agency.

And defining someone as incapable of making good decisions is extremely ethically fraught. Autistic people are often highly capable in other areas, mathematicians are often autistic. Is the basis someone just doesn't fit in? No. Then what is it?

On the other hand, there is a very good reason to do this, oftentimes they pose a significant danger to themselves and other people. The problem is not confusing not knowing what you are doing with not understanding why they are doing what they are doing. In the former, it's a valid approach. If you confuse the former with the latter, well then you get problems.

"Suppose someone has an irrational fear that someone is watching them, someone is going to take over, they constantly feel trapped and that someone is going to deny them choice. So you go to a psychiatrist, and diagnose the patient with paranoia / psychosis, and then put then under surveillance and guardianship."

In fact that never, ever happens. Surveillance?! Are you kidding. The state doesn't give two shits about schizophrenics, much less spying on them. Guardianship? Uh, no, not by a very long shot. There are five questions a judge will ask when a psychiatrist tries to put a patient on an involuntary hold for treatment:
(1) Are you able to provide yourself with food? (The individual only need answer that they know how to dumpster dive and they know where the local soup kitchen is.)
(2) Do you have shelter or a place to live? ("I have a tarp for when it rains and a blanket under an overpass for when it's cold" is sufficient here.)
(3) Do you have clothing? (If the individual is dressed, this is largely answered. If they know indicate they know where to find a coat in cold weather, the they get bonus points.)
(4) Do you have the current urge to kill yourself and a plan to carry that out? (Pervasive depression, chronic suicidal thoughts, or previous suicide attempts are the same as a 'no' answer.)
(5) Do you have the urge to attack or kill any specific person and the means to do so? (History of violence, unfocused homicidal thoughts such as 'sometimes I feel like killing people' or hyper-vigilant aggression 'I'll smash anyone who messes with my tarp or blanket' are the same as a 'no' answer.)

Seriously, that's it. And those are the criteria for involuntary psychiatric confinement, which by law is limited to 3 days, and then requires a patient interview by a court representative, and then court approval, to be extended an additional two weeks. Only two 2-week extensions are allowed, so after 31 days it doesn't matter how the individual answers those questions, they'll be released.

Again, that's for involuntary hold. The threshold for guardianship is substantially higher.

This is an extraordinarily complex and nuanced topic, and Tyler's column, while raising a good overall point (the custodial system is a complex mess), paints the issue with a simplistic and broad brush. Read Mark Delp's comment above, for example. When I was a practicing psychiatrist, some of the most heartbreaking cases I dealt with were the families that became guardians of adult children with severe disabilities and/or mental illness. It usually more than a full-time job - it can be all consuming. It is sometimes dangerous, and always expensive. I recently had a coworker give up her career and fly back to her family home because her mother became terminally ill and her severely disabled adult brother had become violent with the home-health care nurses because he was unfamiliar with them. Her life is now literally and completely devoted to caring for her brother. She's a devout Christian, and so is will to become her brother's keeper.

I'm trying to think if I ever saw a case, or even heard second- or third-hand of a case, where someone was under guardianship while being able to live independently and take care of themselves. Never saw it, never heard of it. Maybe, as Tyler suggests, it's common, but I don't think so. While guardianship procedures vary widely from state to state, it is usually a very difficult, time-consuming process. And once it's achieved, the processes that support (and monitor) guardians and inadequately funded. I suppose there are cases where a wealthy family may get custodial care of an adult child and institutionalize them, with the goal of hiding some embarrassment (e.g., Rosemary Kennedy), but today the reality is that it is generally an act of extreme selflessness and sacrifice for most families.

Decades ago guardianship was much easier to obtain, and huge numbers of the disabled and mentally ill were institutionalized, usually on the state's dime. It was pretty awful, and laws were changed. No one considered where those people would go, since very few of them were in fact (as Tyler imagines) able to care for themselves independently. So they ended up on the streets, or in jails. The government money that was saved in not funding the asylums and institutions was not spent on community services and social work. Do this thought experiment - imagine proposing to communities and states that they either raise taxes, or cut other services, to provide community services and support to allow fewer guardianship cases among adults with severe autism or other disabilities. Let me give you a hint - the ONLY people who care about this issue are the families of those with disabilities.

One exception is among the elderly. There is indeed a big business is finding demented and infirm elderly who often have substantial assets. And I think there is a non-trivial number of greedy family members willing to exploit the process for themselves. Getting a guardianship in these cases can mean good money (of course, when it comes to family, guardianship is rarely required to exploit grandma and grandpa). Indeed, there's a large and poorly monitored industry that has arisen around extracting money from elderly with no family. But is this happening to the severely autistic? I don't think so. If they don't have Mark Delp to step, they're likely SOL.

“After recent revelations about institutional racism,” and what would those be Tyler? This discussion isn’t new. No new “revelations” have come to mind. This is a clumsy attempt to use recent events to make your point. Unnecessary and, in fact, undermining. Not all conversations need to be about racism.

It's armour for the USS Cowen in case she comes under attack.

Perhaps TC has in mind that, controlling for the base rate of violent criminality, white Americans are killed by police at a higher rate than blacks,

That has been debunked.

when & where has that been debunked?

On the internet. You must have missed it.

+1 chortle
sounds like it gotta canceled by the leftist marxist cancel culture
not debunked

To be fair, arithmetic is an aspect of white privilege.

>how little good information

Yeah, and you are certainly not helping by your knee-jerk throwing of racism into the mix. Lefties just can’t help themselves.

"Have you ever wondered how previous generations tolerated or even encouraged so much racism, prejudice, segregation, incarceration and other abuses of human rights? You don’t need a time machine to find out."

Life is short, and while it is lived, its moves quickly, and most of us are desperately preoccupied with the problems of figuring out who we are, getting educations, establishing ourselves on a status escalator, finding mates, setting up households, raising children, wondering wither we are bound, trying to work around our own physical and emotional limitations, and making plans for the future that bears down on us all too quickly, bringing with it either the accumulated surge of our life's failures, or the annihilation of powers in old age, making it difficult enough for modern people to give their attention to addressing social injustices, especially those that seem to be acceptable to everyone else, much less the people of earlier times, who enjoyed far less wealth and leisure, were more strictly constrained by custom, and, unless they were of a wealthy and protected class, could bring real harm upon themselves and their families by attacking widely accepted injustices.

Effective social reformers who aren't wannabe dictators are like successful innovators. They're rare. So many factors must come into play to create them. And that's why those individuals who pull it off are so widely celebrated. (See Gwern's "Why is there only one Elon Musk?" )

I agree, and said similar above. And "Why is there only one Elon Musk?" nails it. As does the pithy answer "because he's crazy."

Note that he is mostly the right kind of crazy for this moment, but for all the value that brings, I worry about him.

He's another Howard Hughes.

Bryan Caplan is not badly treated by anyone.

I've been waiting for the Straussian interpretation of this blog post. Don't cry for me Argentina seems the most obvious. Maybe Cowen is the Christian I never knew. Why be sad for the Blackish when there's the Autistic to anguish. Culture, race, and religion separately are sources of conflict and misery, but taken together they are a toxic brew. Subversives are hiding in plain sight, while Cowen has in mind the demimonde to vanquish.

I would submit that you have things almost precisely backwards. For my experience with no incentives to appoint guardians, I see far more patients who would benefit from a guardian and who have trouble passing my basic medical competency checks but have no one willing to go through the guardianship process.

On the flipside those who are able to function in society are currently getting hammered by all sorts of trends. There is, of course, the trouble with literal minded folks navigating all the newspeak required for dealing with racial and gender matters (e.g. nobody cares if you have a functional psychiatric illness when you cannot fathom why "he used to be a girl" is anything other than a literal statement of fact). Worse, society has become ever more constrained around "fit" and "passion". Both of which mean that interviews are basically giant anti-autism filters. After all when you cannot use normal language to demonstrate your passion (e.g. you start talking in a highly analytic way about something) or when you fail to pick up social cues or do appropriate small talk, well welcome to the bottom of the interview heap. God help us with neuroatypicals navigating the quagmires of sexual consent in any consistent fashion.

Guardianship involves a well structured process which highly functional autistic patients are actually decently equipped to handle. There are explicit rules and many instances to show both capacity and competency.

Do abuses happen? Of course. It is a system run by humans. But I would submit the much more common violation of autistic rights happens to those who have capacity and navigate a world that is increasingly hostile to those who cannot code switch, conform, follow idiosyncratic rules, or read between the lines.

+1 nailed it

Precisely. Again, as a parent of an adult with moderate autism, I believe there are too few of his peers in constructive guardianship, not too many.

The problem with guardianship isn't so much the process in which it is created, for obtaining it will be difficult if the ward objects and can mount an adequate legal defense.

The weakness in the system is that neither the courts nor state government in general has the resources or the will to provide sufficient oversight to ensure that the guardians are, in fact, acting in the ward's best interest (let alone ensuring that the ward is subject to the required "least restrictive environment" consistent with the ward's condition and capabilities.

Similar problems happen in the foster-care system: it's not all that easy for parent(s) to lose custody if/when they're determined not to, but, once the minor has entered the foster-care system there's often little or no effective oversight of the foster home.

It's hard to see this getting better anytime soon, as the problems lie more downstream than in the initial legal process. And so long as the state lacks both interest and resources to provide adequate oversight, abuses will continue.

Live Free or Die, Death is not the worst of Evils. Gen. John Stark. New Hampshire’s most famous Revolutionary War soldier. And now State motto.

I always thought it was Eat S--t and Die.

"Live fast, die young, and leave a good-looking corpse."

Perhaps there are many people in guardianship who ought not to be; if that is happening, that is very bad, but that is the question that needs to be answered. Introducing the topic of autism confuses things even further, because what is often described as autism online is a very different thing to the condition that often leaves people completely unable to communicate and unable to maintain their own personal health and safety. Like some other commenters here, I know a person with this condition, and the lack of a guardian would be basically a death sentence.

The best point the article makes is the call for transparency, but that applies across the whole criminal justice system as well.

So, I wonder if those who are human rights purists on this issue would say that people with Down syndrome should not have guardians. Or people with severe cerebral palsy, or Fragile X syndrome? People who have IQ's of less than 25?

It’s simple. If an adult rejects help they are free to. The concept that a person with schizophrenia needs to be controlled by someone else is totally a reflection of that other persons values. Not the person you want to control. Get over it. It’s not purist to reject Nazi values. And don’t think you can go part way. Reject human rights and you’re on the way to totalitarianism.

thats simple
thats more than a little too simple

Back here on earth, and leaving aside (if you wish) the cases where people with schizophrenia object to being placed in guardianship, I have several family friends who have been so placed to their immediate benefit, and they would agree. Several with Down Syndrome; a couple with progressing dementia; one with physical challenges so severe that the burden of handling his own finances/living arrangements are more than he can handle. In that case, the guardianship specifically states that if he disagrees with actions taken by his guardian, he can go back to court and get the judge to disallow that action and/or appoint a new guardian.

Just last month, I gained guardianship for my 18-year. He has high functioning autism and epilepsy. While my son does not have an intellectual disability, other aspects of his condition - OCD, poor social skills, reading disability, severe medical issues - made us believe that could not care for himself properly. We did not make discussion lightly. We consulted various medical professionals. We had to pay a lawyer $5,000 to process the paperwork. The court appointed a lawyer for my son to represent his interests. We are working to help him gain the maturity and skills that he needs to manage on his own. We would LOVE for him to be independent. But the truth is that the world is not nice to autistic people. There is no safety net. I think he would be homeless on the streets or dead without our supervision.

Thank you, Laura. It's pretty clear, if your read between the lines in history, that impaired adults have always been "guarded" by their relatives, informally and with no oversight. Such that, with no standards for guardianship, many lived in dangerous situations or died young. Imposing standards merely regularizes the reality, and sets up some guard rails for the protection of the impaired adult. Are these situations exploited? sure, but not nearly as much, I would imagine, as those adults were exploited when they were at the mercy of any relative or stranger who asserted power, or any threat coming from their environment.

I am ASD and ASD is not like racism. Racism is fairly impersonal and when white people get to know black people, they often change views on them (and vice versa).

Not so with ASD. When people get to know us, a significant majority will form strong negative opinions about us where they had probably a neutral opinion.

I work at a STEM type job in finance and its a lose lose. You can't "hide" your ASD. But if you tell people in a work context, you lose anyways. I have had to put up with brightly lit open offices when I know in my heart I am most productive in a dark closet (yes, I literally do most of my work at home in a closet with a fan).

Yet you know if you actually told your boss that, and somehow they allowed you to work in a tiny closet with a fan, you would get made fun of so much and your coworkers would see you as the weird one. And you know? I guess they are right.

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