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Boss of Czech child psychiatrists on Greta

Greta perceives fear and anxiety, she sees a black-and-white world
The whole family needs to find a help by psychiatrists

An interview with Dr Jaroslav Matýs, the chairman of the Czech Union of Children's Psychiatrists and a court system's psychiatry expert.

The speech by the 16-year-old activist Greta Thunberg on the New York summit has resonated since the beginning of the week and filling the media realm. It was also observed by the respected psychiatrist Dr Jaroslav Matýs. And he has observed much more. The performance by the girl that has become a global celebrity and that doesn't hide her Asperger's Syndrome, is a theme that Matýs follows for a long time, for reasons related to his occupation. He talked about the specific aspects of this disorder, the role of her parents, as well as the view of the world according to the autistic people.

You have seen the speech that is so widely discussed. What do you think about it?

It shows an immature child with autistic problems and without a glimpse of a social perception.

Greta has a milder version of the disorder – the so-called Asperger's Syndrome. It's not an autistic person such as Dustin Hofmann in the famous movie Rainman...

It's just a subset of the same condition. The term "Asperger" only sounds more cultivated. It is autism combined with a very good intellect. At any rate, it is a very serious psychical disorder of the personality and I can see she displays all the typical symptoms.

You know, out of my 1,000 patients, 450 are autistic. I dare to say that my experience with them is long and deep. They cannot distinguish the good and the evil. They don't understand what justice is. When you ask Greta what she means when she says "they have stolen my childhood", she won't be able to explain it. Well, yes, she could explain it technologically: when the childhood starts and when it ends. These are just memorized formulations that she has received somewhere but not her own perceived experience. It would be similar if you asked her whether she is happy. People like her can't say anything about such easy questions because the mechanisms she has copied from an external source doesn't go far enough to produce an answer.

Incidentally, I also have a patient whose mom told him: "I am your everything". And then she goes somewhere in the evening and he can't understand why he doesn't accompany her. She interprets everything that he hears totally literally. To understand what is being told to a person, one needs the so-called social intelligence. That context that is important for one's life – but people like Greta don't have it.

So what can be done about it?

You know, there have been just several geniuses who have moved the world. Yes, many of them have been ill as well. But they had the environment around them that could keep them within certain bounds.

You are pointing at the parents.

Certainly. She has opened and named a topic. It was done by a person with a special character. Globally. Very well. What is wrong is that the generation of hers is identifying with it. One can truly be a good person who wants to help mankind, albeit fanatically, but without the knowledge of the rules, it's hard. The inertia of an autistic child is hard to modify.

As far as I know, she has publicly admitted to suffer from the obsessive-compulsive disorder, Asperger, and ADHD. A healthy person wouldn't do it. Only a person who doesn't care about the social implications of the admission may do it. And she did it exactly because she was instructed by someone to say it in this way.

How important role is played by the parents in this story? Are you saying that these gedanken bounds must be given to the ill people by someone?

Sure but it is the whole environment. People don't realize that there is a particular individual character underneath every psychological disorder. I have autistic patients who are nice. Then I have some who enjoy hurting others. What matters is to find a topic for the autistic person that is close to him or her and for the family to explain where are the limits.

It's a problem in Greta's case that the family hasn't caught the moment when she was getting stuck in one topic – a process that usually starts in puberty. It may be sex, animals, fascism or something similar. And it's fine that the person has a positive theme. Sure. But it must be given a social framework because when the autistic person moves in a direction, it's hard to modify the direction later. She is worried about the fate of Sweden and mankind but I can read in her face that she is worried about herself. It is a difficult psychotherapeutic work when the goal is to alter the direction in which the adhesive kind of thinking evolves. In this case, I can see that the parents have mostly failed to do it right.

I have a patient who was a kind of a silent peaceful boy in America. Also an Asperger's sufferer which is said to be a mild form of autism. I disagree with this description – the only true fact is that Asperger is easier to be compensated when one gets older which doesn't mean that the person suddenly starts to have some social compassion. He or she simply learns how to behave. But let's return to that patient. He was telling me that we should establish a new Auschwitz, like in the past, because gypsies should simply be sent to gas and we shouldn't worry about the consequences. I've been working with him for three years. I don't want to say that the efforts were futile. But in the autistic people's case, it greatly matters what information hits their radar first. And that's the one they are working with, without compromises. Either they may become a Nazi or a fascist, or a blinded savior of mankind that follows his or her agenda.

And that's also the case of Greta. When you look at her artificial and exaggerated facial gestures, the trained motion of her lips, her focus on the words and sentences, intonations... You may see that she almost cries but it suddenly goes away. This is typical for autism. Also, you may listen to the speech carefully. They may memorize and reproduce whole segments of texts which belong to their topic. For example whole chapters from a book of fairy-tales. But they say it with a flat intonation without emotions.

A clear objection questions whether you may produce such a diagnosis remotely. Is it ethical?

First, I wouldn't dare to do it in the case of a person who doesn't publicly admit the diagnosis. And I wouldn't create a comprehensive diagnosis remotely, either. I don't have the right to comment on the diagnosis produced by a colleague publicly. But it's different with her because: she has revealed quite some details about her diagnosis. And that information is clearly readable.

I have been an expert witness in the courts for many years. You really cannot immediately identify psychopaths or sociopaths that are torturing their families. Not even those who are top managers in companies and torture their employees. But what you may distinguish very quickly is Greta's diagnosis. So my situation is analogous to that of a car mechanic who has done his work for years and who may say "a faulty gearbox" when he hears the sound. And every experienced psychiatrist or clinical psychologist may see what I see. At least he or she should.

Before we started the interview, you said that you were watching whether she smiled...

It wasn't just a short smile – she did smile. And that's another typical sign of this serious disease although even the mere absent smile may be a warning sign. When such a person is happy, it is a very short, one-second-long event. Neither sorrow nor happiness is being experienced by them, the emotions are flat. On the contrary, the anxiety attacks last a very long time. However, they are directed towards themselves, not the environment. They are primarily worried about themselves. And Greta is going through that fear and experiences it profoundly.

You were saying that the "disease is genetically pre-programmed as a brain disorder and no one can predict where the brain will evolve, e.g. which kind of undesirable outcome will arise". How does it happen?

As I tell you, it's genetics. You are born with a brain that is predetermined for the states of anxiety, for the evolution of schizophrenia, with a brain programmed to suffer from ADHD... That's how things are. All of them are very serious brain disorders. The essence of autism is the social flatness, however. And there's basically no therapy.

The reason is that you can't learn emotions, you either have them or not. The brain is a living organ that may evolve but the point is shown by an example: the brain may expand its center for speech, to learn a language. When a feral child is found at the age of ten or twelve, you will no longer be able to make it speak. You may just try to help the brain at an appropriate moment and Mother Nature will decide whether things will evolve in the optimistic direction or not.

Is there a cure?

No, you really cannot cure that.

But it seems to me that due to their bulldog's persistence and abilities to persuade, they may have a good potential for high-ranking jobs.

That's totally true. My colleague Dr Radkin Honzák has been saying for quite some time that we have ill sociopaths in the highest political jobs. However, they mostly end up with purely technological jobs such as IT firms, banks and so on. This is even shown by some statistics. They go to places where things are divided to black and white. But the world isn't black and white, it's colorful.

Isn't it too harsh an evaluation of a single girl who just pointed out that we are destroying our planet?

Yes, great, let's return to her. If you will have one idea that you will declare correct and obsessively follow the idea, then it really is a serious diagnosis. That condition is usually accompanied by paranoia because 70% of autistic people are paranoiac but it's an unfortunate fact of psychiatry that you can't reach an agreement with a paranoiac sufferer.

The whole world listens to her, however. Whatever her characteristics are, she is influencing millions of people.

You know, I am viscerally dissatisfied with the fact that the politicians who are meeting her aren't discussing this set of topics with the experts and they don't give an appropriate framework to all the events. They should say: "Thank you that you have alerted us, we understand that you have a black-and-white perspective on the world but this isn't how the world works or how it can work."

But she is really being applauded by millions of people – from kids to politicians, sorry.

The regular people cannot read these formally emotional processes. And the autistic people only offer formally emotional speeches, declarations.

It's a very sensitive theme on a human level, what we are discussing here.

Maybe for you but not for me as an expert. And I can tell you that psychiatrists are already getting upset by that. We have waiting rooms full of autistic sufferers. And we don't like that nothing is happening about the disease. What I see is the widespread exploitation of the autistic people.

Do you believe that a psychiatric care would be more appropriate for Greta?

Not just she but her whole family needs it, too. It's not really just about the child. A much more important role is played by the parents. In many cases, it's the parents who want to feel the publicity. Actors. I often encounter these examples in my office. Who can explain the socio-economic contexts to Greta in her family? I don't know. But I know one thing: later, it generally becomes very hard to fix what was neglected when the autistic person was young and when he or she wasn't constrained by any bounds.

Questions by Ms Lenka Petrášová

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