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About 30 years ago, I dated a girl who had an autistic sister. She wasn't the "nerdy" kind of autistic, she was the "can't speak at all (as far as anyone knows) and huddles in a corner grunting" kind of autistic. She was 20 years old but obviously never going to be capable of taking care of herself. Sometimes her parents made us take her with us on dates, both to give themselves some rest and (presumably) to limit our friskiness.

There are levels of psychiatric disease that can reasonably by interpreted as preferences. There are also people who are truly, fundamentally broken. I suspect that the utterly mad form a large part of Dr. Alexander's reference pool and much less of Dr. Caplan's, and I suspect that to be the basic cause of your disagreement.

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I presume that sister would be incapable of taking care of herself even with a gun to her head. Thus, by Caplan's standards she would have a disability rather than just a preference.

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What if she could take care of herself if a gun was pointed to her head?

But that it took that level of extreme force and it had to be applied constantly.

Would she no longer be disabled because under those extreme circumstances she could summon the willpower overcome her problem?

I mean people are capable of all sorts of things if the threat of corporal punishment and death are ever present.

But nobody would seriously suggest that someone follow this girl around with a gun to her head. Nor I would guess to cut off whatever support she gets because she could “in theory” overcome her issues.

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As I said elsewhere, I prefer the term behavior instead of preferences for various reasons. This is one more reason. She has a maladaptive behavior How do you know that with the right therapy or treatment (maybe one nobody yet knows how to apply) she couldn't be helped and become able to function and take care of herself?

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