In order to receive a clinical diagnosis of autism, a person must meet certain criteria. Aside from the damaging and negative language that describes our way of experiencing and responding to the world as deficits, these criteria don’t really tell us anything about “being” autistic. They are interpretations through the medical and neurotypical gaze of what autism looks like if you aren’t actually autistic yourself. (Not dissimilar to claiming the scientific “proof” that a coconut is in fact a mammal because it has brown hair and produces milk – it certainly meets some of the criteria for being a mammal!)
A clinician with absolutely no understanding of what it is like to be autistic could take these criteria and use them as a checklist against which to compare a person. We know Autistic people protect themselves by masking or camouflaging their autism (sometimes automatically and without choosing to), and we know that certain groups of people are less likely to receive a diagnosis of autism and are more likely to receive differential diagnoses that overshadow their autism. The road to correct diagnosis is a rocky one. But this blog is not about that. These are areas that desperately need further research and exploration, but I will stick to my theme of autistic traits indicating self-care rather than being the deficits so often described.
What do we mean by self-care?
A dictionary definition of self-care describes: “The practice of taking an active role in protecting one’s own well-being and happiness, in particular during periods of stress.”
In popular culture, self-care has become synonymous with bubble baths and herbal tea, but self-care can actually be an act of political warfare, or simply the stuff we need to do everyday to be at our best. Proactively regulating ourselves through increasing and decreasing sensory input can be part of our self-care.
For instance, we might wear noise-cancelling headphones in a shop, so we can reduce the sensory input from the speakers blaring out loud music and the background noise of extractor fans and chattering customers. This may make us better able to socially interact with the shop staff and complete our transaction less painfully.
What if we don’t have those noise-cancelling headphones to hand?
We might make a repetitive noise, repeat words out loud, or hum a note that blocks out all that background hubbub. This could have a number of effects, including:
a) our noise blocks out some of the background noise
b) it creates some predictability and therefore, feelings of safety in an otherwise stressful situation
c) it may provide regulating sensory input through the pleasant sensation of making the noise with our mouth
How might this look to an observer?
Observers might think various things about us making a repetitive noise – anything from a lack of understanding, “why if they don’t like noise are they making such a racket?!” to the more pathologising observation that the person is showing stereotyped and repetitive use of speech or hyper- or hypo-reactivity to sensory input. Both opinions offer up explanations from an “outsiders” point of view rather than understanding autism from the inside.
How many other traits of autism are in fact Autistic people practising self-care?
I have worked in the field of health and social care for 30 years and have met Autistic people who have severe learning disabilities and physical disabilities, Autistic people who are articulate in using speech, signing, actions and gestures, and other forms of communication. I have had Autistic colleagues and friends. All of whom meet those criteria for diagnosis set out in the DSM-5. Each Autistic person is unique, just as everyone else is unique – that is why we refer to the human race as neurodiverse – all minds are different.
My professional and personal experience tells me that Autistic people instinctively and intuitively do what we need “in protecting one’s own well-being and happiness, in particular during periods of stress.” And my goodness, it is stressful living as an Autistic person in the world. No wonder we have to find ways to protect our wellbeing.
What else could be going on?
I would love to hear your comments, reflections and thoughts. Here are a few of my own examples of how those “deficits” described in the diagnostic criteria may in fact be coping strategies and self-care activities used to help me exist in a world that is so frequently not set up for people like me:
My social challenges often come from being overwhelmed due to having too much sensory information to process. When I am better regulated and therefore not in a survival state of fight, flight or freeze I am more able to access what is referred to in polyvagal theory as my social engagement system. The things I need to do to be regulated may look different to those things non-autistic people do. This isn’t due to a deficit, but simply down to my experience of the world being different to theirs – seeing as my experiences are different, no wonder my responses look different too!
I use my body to self-regulate – how wonderful is that! When I have no equipment to hand I can still move my arms, bounce up and down, or make a favourite noise repeatedly. (referred to in DSM-5 as stereotyped use of movement)
My so-called special interests are not special in terms of topic – it is not my fault that other people seem to select from a somewhat restricted choice of interests. The abnormal intensity and focus following these interests (as described in the DSM-5) brings me a sense of calm, a sense of achievement in a world that frequently puts me down, and an opportunity to recharge. All great examples of self-care. In fact, some research by Porges described in one of his books about polyvagal theory and feeling safe, quotes: “a reduction in heart rate variability was a robust indicator of sustained attention and mental effort”
My sensory responses are only hypo- or hyper-responsive, or abnormal, if you are comparing them to your own experiences and assuming yours are “normal”. In our neurodiverse human race where each of us has a wonderfully unique mind, how can we define normality anyway? When you understand that my sensory experiences are different to the majority of peoples, you may begin to understand that my responses are different too. Different, yes; AND proportional to my experience. A proportional response cannot surely also be a deficit?
It is difficult to define autism. In my opinion, the DSM-5 criteria offers a highly restricted view of autism that is fixated on how autism is perceived by non-autistic people. It does not focus on the many strengths that autistic people have, including how we frequently incorporate self-care into our daily lives. I would like to reframe some of those deficits as instinctive ways Autistic people practice self-care.
But I do not believe that simply swapping a list of deficits in the diagnostic manual for a list of strengths, will improve things – the list of strengths is simply the other side of the same coin. But by flipping that coin over, we begin to consider autism from other angles – and that is important. I believe that autism research needs to move from an almost total focus on research topics concerning the biology, causes and treatment of autism, to topics that seek to understand the experience of “being” autistic. The times in my life that have been most positive for me, have come about through people accepting me, valuing me and seeking to better understand how it is to “be” me. Being able to quote diagnostic criteria or hypothesise over genetic factors that could have contributed to my autism have done nothing to improve things for me. I speak in more depth about autism research in another blog.
So, how can we reframe autistic deficits as self-care? Education and awareness raising are a good starting place and there are many fantastic individuals and organisations doing just that.
I made a personal change in how I use language. I stopped using the words hyper- and hypo- in relation to my sensory experiences after we wrote our Sensory Trauma position paper. Instead, I focus on the experience of “being” autistic. I choose to use phrases like “my tactile sense is heightened” or “my interoception, or awareness of body sensations like hunger and pain tend to be muted”. These expressions are finding their way into more mainstream usage with our National Autism Team here in Wales now referring to heightened and muted sensory experiences in their latest information. This is positive because it better helps people understand the experience of being Autistic. Autism is not a set of symptoms to be ticked off against a list.
For me, being autistic is about how my whole being – my body, sensory systems, brain, everything about me – interacts with the world. It is about the relationship I have with the world. A relationship that is affected by how I perceive the world through my different sensory, cognitive and social experiences. A relationship that is also affected by how the world perceives me. I cannot do much about being me, about being Autistic – and nor do I want to. But I can do something about how autism and Autistic people are perceived… we all can….
In my previous blog Saying “Ouch” in all the Wrong Places, I describe our sense of interoception and how my sensory processing differences result in my brain receiving very muted signals about what I feel inside my body. The blog gives some examples of how this manifests for me and the challenges this creates when attempting to describe medical symptoms and access appropriate medical support.
Today I visited the dentist. Dental appointments would have been unthinkable when I wrote that earlier blog, but with support over the summer, I have had several visits to the dentist, requiring x-rays, a tooth extraction and follow up treatment for ‘dry socket’. I went back today because I was experiencing symptoms of severe pain.
Note that I state experiencing “symptoms” of severe pain and not “experiencing severe pain”. Whilst my muted interoceptive experiences have remained similar, my understanding and acceptance of what they mean for me has changed considerably.
Each of us experiences pain differently. It’s common knowledge, and we often attribute unhelpful value judgments to people’s experiences of pain. The way that our brain processes the signals that come from our body is unique for each of us. It is dependent on the context too, and can fluctuate. This is accurate for all people, but Autistic people and those who experience sensory processing differences for other reasons, may experience sensory information in different ways. Not just internal body signals; but noise, taste, touch, smell and visual information too. We may experience sensations intensely, or they may be muted. Sensory information could be distorted or fragmented, or take a long time to process.
My personal experience of pain tends towards not noticing it until the sensations are very strong. This is not because I am some brave superhero – it’s just how my sensory processing system works. My brain requires lots of interoceptive sensory information to register something is happening. Conversely, my tactile processing system needs only a tiny bit of sensory information to register with my brain and I can incorrectly appear to be oversensitive to labels in my clothes, or having wet hands for instance.
How I experience pain:
Just because I may not have a strong awareness of something in my body hurting, doesn’t mean I am not in pain. If a medic asked me to use a pain scale to rate the severity of my toothache this morning, they would have been met with a puzzled look and a “I’m not sure….It’s not too bad, I suppose” – I certainly could not have attributed a number between 1 and 10 to indicate how severe it was. In fact, the stress of trying to define what was wrong and where in my body that sense of something being wrong was located, could have pushed me into complete overwhelm. But I was in pain – only I didn’t feel it in the conventional way.
On Saturday I recognised a change in my mood that was not related to any circumstances or life events – in fact I was having a great day with lots of absorbing activities to occupy me. I found I could not regulate my sensory processing system – and as someone who is proactive in sensory regulation and incorporates it as part of my lifestyle, this concerned me. It was dramatic enough to make me realise that something potentially serious was going on; and because I have an awareness of how I experience pain and illness, I explored whether it could have been caused by pain.
I scanned through my whole body, inch by inch; noticing whether I could detect any sensations, or none at all.
I tried to put my “something is wrong” feeling into words but couldn’t. So I didn’t push myself.
I distracted my mind from disappearing into my black mood in search of why “I” am so wrong, and brought my awareness back to my body. This required a huge leap of faith on my part as I have experienced extensive negative feedback from professionals about my insights into my own needs. However, I know myself well and there is little to be gained by stressing over whether I will be believed or not – or whether I am making a fuss about nothing. My dysregulated sensory processing system and my distressed emotional state that could not be regulated by my typical everyday self-care, told me that I was most likely unwell or in pain.
I checked I did not have Covid-19 and my lateral flow test was negative. I tried to notice any symptoms, such as a runny nose or a cough, or limbs that were an unusual shape, but couldn’t detect anything of note.
I considered the type of negative thoughts I was having and rather than challenging them or getting drawn into them, I stood back and wondered what they were trying to tell me…
Noticing where my pain is:
Using my skills in logic and analysis, observations from years of supporting people who communicate without talking; and combined with past knowledge of myself, I considered I may have toothache. I had needed dental treatment in the summer, so this seemed a strong possibility.
I examined my mouth and face in more detail. I noticed that if I touched my jaw I felt slight pain. I looked in my mouth but saw nothing that indicated swelling or infection. As the day wore on, and into the next day I found that I noticed slight earache as well as the sensitivity when I touched my jaw. It was as if the overwhelming and widespread feeling of something being wrong was settling in one place. The sensation was certainly not pain that could be classed as severe, but I recalled how the abscess that had required a tooth extraction in August had created similar mood changes and sensory dysregulation in my body.
When I visited the dentist in the summer they tapped my teeth and explained that if there was a problem I would soon know! I did not react with a typical pain response but the x-ray showed what they referred to as a pathological cyst. When I viewed the x-ray back in the summer, it enabled me to place my pain in my body, and my mood symptoms lifted, I was more able to regulate myself and I began to notice my toothache and could treat it with painkillers.
I decided I would telephone the dentist on Monday morning. I pushed aside my anxiety about making a fuss and made a plan. I knew the dental receptionist would ask if this was urgent and would qualify that by asking if the pain was so severe it was keeping me awake. This line of questioning delayed my treatment in the summer because I answered honestly and said “no”. However, I realised back in the summer that I was incorrect with my response of no. The pain was preventing me sleeping because I was having nightmares, distressing thoughts, and panic attacks. These symptoms that are typically associated with mental illness are closely linked to physical illness in my case. My nights have been disturbed for some weeks and although I have not had a sensation located in my mouth that has kept me awake, the pain has kept me awake by manifesting in other ways.
The receptionist was accommodating and listened as I explained that my pain was as bad as it had been in the summer. Fortunately I could have an appointment later that morning with the dentist who knew me well. I have very specific support needs when visiting the dentist and was relieved to be seeing someone who knew me.
My appointment resulted in confirmation that my cyst was still there, in the same place and the same size. The extraction and weeks of antibiotics had not healed it. Further treatment is booked and I left feeling reassured.
I am learning to trust my own knowledge of how my body works. This is no easy task when my life has been filled with invalidating comments, disbelief and failure to address my needs.
Some people work hard to identify sensations in their body and name them “correctly” and describe them so they fit mainstream expectations of how bodies work. I feel no need to do this. I prefer to develop my self-knowledge and accept this is how MY body and brain works. I would like more people to accept the way my body works is “normal for me”.
At times it may be helpful to frame my experiences in ways that clinicians accept and understand, in order to receive timely and responsive treatment, but I do this purely for that reason and I would love to be able to use my own language and lived examples, and be taken seriously. Sadly, if I explained I had mood symptoms and thought it was actually toothache, I would likely be seen as neurotic. I get better treatment by stating I am experiencing symptoms of severe pain. Those times when I am unwell or in pain are not the best time for changing attitudes!
Locating the pain reduces the risks that come from being so dysregulated. It also enables the pain to be treated.
It is interesting to note how once I have located where the pain is likely to be, I start to feel it slightly. When the location is confirmed by x-ray or other tests, it begins to hurt more. The overwhelming sense of not being ok that fills my body, condenses into its correct place. Clinicians can really make a difference to people like me by listening with interest and without judgment. Learning to explore your whole body and notice anything different can be useful too. I have used mindfulness for decades and find body scans help me. Pain scales are not a good indicator of severity of pain for some people – what is more useful is having trust in the person’s ability to notice that something is not right for them – and then support them to explore it.
I have no energy for masking at the moment and know that this means I will either appear totally unstable or I’ll muck up everything I have worked so hard to create.
It makes me want to give up as there seems no point.
Situations remind me that no matter how hard I try, how well I mask, and how fantastic my skills are – I am still really crap at being a neurotypical person. But I’m not neurotypical so why does it matter?
Because autistic people are not valued as whole people. My skills can be appreciated but the rest is still measured in deficits.
People assume I want to be more normal, or I’ll somehow learn to fit in. I don’t. I won’t.
I want the whole of me to be appreciated.
I often find neurotypical people dishonest, vague, inconsistent and tricksy. I still love many of them though. I accept I find those aspects of their persona difficult and confusing. I may not even like how they do things sometimes. Perhaps they occasionally annoy me. But I still love them and wouldn’t dream of writing them off as lesser, or as a broken version of me.
We are all perfectly imperfect human beings.
That’s why I’m fed up of being autistic today. I’m tired and overwhelmed and have no fight left. I get more tired anyway because my brain does so much more processing. On top of that I have to put all that effort into fitting in so I’m allowed to have a go at normal stuff like work and friendships.
My brain rarely rests. My body is usually alert to danger and ready to react.
Most people don’t realise this, and when I end up having to tell them so they’ll stop unintentionally hurting me, I feel humiliated and reminded of how the world is not designed for me.
That’s why I’m fed up of being autistic today.
So I’m taking it easy. I’m cuddling my dog. I’m taking care of myself and hoping tomorrow will feel better.
Self-care is the only way. I have a capacity for joy that others may never achieve. I seek out those sounds that reset my soul. I notice the patterns the rain is making on the window and trace each tiny droplet until it has my full focus. I read those comments that remind me I am not alone. I move in ways that reminds me I am in here – I have a right to be alive.
I rest, I recharge. I don’t plan my next battle. I remind myself that this neurotypically biased world is not of my making. I look at the birds and the trees and I reflect on the words of Mary Oliver. I remember where I belong.
My dog has just come in and jumped up on the bed to see me – I can smell the weather on her. It feels exciting to be able to tell that autumn is approaching, just by smelling my dog!
We take the same walk every day, down the track and across the field to the little piece of woodland that looks out over the meadows to the distant river and castle. I’ve walked this route for 20 years – either with Blaze, or with my previous dogs. I never get bored of it though, and I take such delight in how it is always a different experience. A good, solid, natural, different experience each time; a difference that is meant to be. Rather than a man-made, enforced, upsetting of the natural order, type of different experience, that makes people think I’m typically autistic and “don’t like change”.
I notice the tiny insects; I hear the far away birds; I smell which animals have passed by. This means I have a whole world open to me that others miss – it is like a great, exciting secret between me and the Universe. It feels special and precious, and an honour. Sometimes my interest and curiosity are stimulated, and I observe and study and wonder at the natural world. Sometimes I just let my senses take it in and I don’t engage my thinking brain at all. The power of my senses gives me respite from the endless mental processing I have to do in order to function the rest of the time.
The physical power of music moves me. I can reset my dysregulated body with just one, single, repeated noise that has the power to rebalance me. I can listen to an orchestral piece and take in the enormity of it, like an overwhelming wall of sound – or I can follow the different instruments, interweaving and passing the melodies and harmonies back and for between them. No tune ever sounds the same twice. Music creates in me something that can’t be captured in words. I see musical chords in colour – and when I see these colours in nature, I hear them in my soul.
My senses work differently to many people’s. I can feel pain and fear from sights and sounds that others find mundane or inconsequential. This can be overwhelming – and other people frequently don’t notice the extent of my suffering. But I can also become overwhelmed by the joy and beauty I discover through my senses. Sometimes I secretly smile inside because I know that I may look calm, bored, or even detached to a casual observer; but in my soul I am full of joy, I am experiencing psychedelic colours; orgasmic noise; and fragrances that cleanse and purge my body and mind.
I can heal my painful and distressing sensory experiences.
I can listen to music; I can walk; I can smell lavender to calm me, or sandalwood to help me think.
I can crunch on pickled onion crisps and allow the astringent flavour to cut through my brain fog and overwhelm – and reconnect me to the world again.
I can listen to the same glissando and allow it to lift my mood, exactly in tune with the rising pitch.
I can move my body so that I know it is me and I am in control and there is something predictable and safe that I have agency over. It makes me be “me” again – I fit back in to the world that so often overwhelms and alienates me.
I am privileged to have a sensory system that can bring me such joy and healing.
A few weeks ago I hadn’t heard of self-isolation but so far I am loving it! I have been enjoying contact with other people more than I have ever done.
That sounds contradictory and even a little facetious I suppose, and in no way do I wish to belittle other people’s experiences. It got me thinking though about how we all take things for granted and how some autistic people will have so much to offer the wider world at the moment. This is because some of the shared struggles in our society during the Covid-19 pandemic are very common daily challenges for autistic people, who have had to learn to cope with them well. I am delighted that so many people are working together and talking about a better world that we can create out of this dreadful and terrifying situation. This is a time for people to listen to each other and learn from each other and share with each other as equals. There may be some viewpoints that we don’t usually hear, or quite likely that we don’t usually listen to because of the biases that exist in society and in our own subjective views of the world.
Now is an ideal opportunity to come together and understand each other better, to learn from each other and have a go at seeing things from different viewpoints. We can all learn from this shared experience of the Covid-19 pandemic. In every other species in the natural world, diversity is a positive thing and an essential component for survival. Isn’t it about time humans caught up?
Before I go any further, we need to discuss empathy. Lots of people have written about autism and empathy – and far better than I can attempt to. You may have heard that autistic people don’t have empathy because they lack theory of mind and can’t imagine how another person thinks and feels; you may have heard that autistic people have too much empathy because they feel absolutely everything. There are different types of empathy anyway – emotional, cognitive and compassionate, for instance. There is no universal definition of how empathy works for autistic or non-autistic people.
This is my personal blog so I’ll describe how empathy works for me – but remember that we’re all different. Some friends of mine who are autistic feel other people’s emotions so strongly and intuitively they find it overwhelming :
My sensory processing is very different to a typical person’s. I hear, smell and see things intensely and notice the details that others miss – in fact I can’t filter any of this out which makes it tough to concentrate or relax; I flinch and jump at a light touch on the arm or an annoying label in my jumper but don’t notice I’ve left half my dinner on my face! I need to walk and do strong physical activities so that I know where my body is and what it is doing or I’ll bump into things and trip over endlessly. It is frightening and disorientating to feel so detached from my body at times.
And internally, my interoception is such that I have attempted to “walk off” a dislocated knee; I have managed several hours of contractions during labour by using breathing techniques and not a cry passed my lips; I may not notice I am coming down with the flu but I will feel unbelievably depressed instead for no reason. I can feel no emotion whatsoever when someone dies or there is a tragic accident – but then it hits me later and then I appear to be dwelling on it, not letting it go and attention seeking, and surely “I should be over it by now”. I don’t have a great sense of what I am feeling and what I do feel is not necessarily accurate so I do not trust my “gut feeling”, in fact, I may not even have one! So, if I have no idea what I am feeling then how on earth am I going to know how you are feeling?
What I understand is gained by observation and learning. I have read a great many books and I have a career in working with people, either in a supportive role, or as a manager. My colleagues include support workers who demonstrate daily how social interactions work; psychologists who tell me “why” people do what they do; psychiatric nurses and psychiatrists who explain “what went wrong” and a multitude of other professionals and families and individuals that I learn from every single day.
So I have developed a good knowledge bank about what people do, some of the potential reasons why, and what an appropriate response should be. And even better, in work this stuff is written down and as long as everyone is consistent and responsive to learning and adapting, then if you follow a person’s support plans or risk assessments you can interact in a meaningful way with people who are really distressed and struggling with communication. It makes me look rather good at all this people skills stuff!
With all this mass of sensory information bombarding me, and no filters; and all the mass of knowledge I need to take on board just to know what to do, things can become overwhelming. I need to compartmentalise things and create rules and systems to work within or else I can’t function. A bit like having some easy to identify folders and sub-folders on your laptop. I am very open-minded because I don’t have filters like “socially appropriate interests for a middle aged woman”, or “cake isn’t a suitable breakfast food”, I don’t get caught up in the excitement of talking about a television programme with colleagues – it creates no emotional response in me. I am not impressed by which car would make me appear most successful or cool – I look at the practicalities of it instead. I am not interested in the hierarchies many people value.
My belief system is one of my own. I have explored religions and share many principles and ways of living my life with a number of different faiths and beliefs but ultimately I don’t believe in any of them at all. I do believe in “doing the right thing”, in “being kind” and enabling people to be themselves so long as they are causing no harm. I am absolutely solid and unswaying in my beliefs. People call this integrity. This is what causes me to be the person speaking out against injustice even though it could be detrimental to my career. It means that I can regulate my own behaviour and act in a fair and consistent way towards other people because I have no ulterior motive and I’m not doing it just to conform or fit in or because I’m frightened of getting into trouble if I don’t.
I don’t “feel” empathy particularly and this can be very useful when supporting someone who is upset or when I managed a residential service for people who displayed challenging behaviour. My reactions don’t tend to trigger other people, there is nothing for their distress to feed off coming from me and I tend to create naturally calm environments around me where emotions don’t escalate because of my interactions or behaviour. I “know” that certain behaviours in another person mean certain things and I combine my knowledge of the individual or situation, and my personal beliefs to create my response to their situation. The down side is, if I have misunderstood or it is a new situation then I don’t know the “rules”. It is also relentlessly exhausting.
Recently I asked a colleague for tips on managing a new situation I had not come across before – the particular type of small talk being used in the Covid-19 pandemic between people who don’t know each other well and want to vent about it. (I am good with talking to friends or family or colleagues about the topic, it’s just this particular aspect I was struggling with). I don’t want to dismiss people, invalidate them or escalate their anxieties but I don’t want to hang around and catch or spread something either! Fortunately my colleague understands me and understands autism so captured it in a way that I understand and can use. She said that when someone random starts talking to me about coronavirus I can use this technique: “Acknowledge (e.g. yes, it is terrible), Divert (e.g. but the weather has been lovely, have you seen all the birds?), Walk away (e.g. I must get going now, bye)” This is a perfect way of managing the situation and explained to me in a way that I can learn off by heart and apply in a number of settings. It also saves me from looking rude, disinterested or going off on a tangent. I have added this to my encyclopaedic knowledge of how to get by in life. This is how I operate. It can feel a bit false and on a bad day I wonder whether I’m some kind of robot and not human, but this is how life has always been for me.
So this is how my empathy works: It is a practical application of doing what is right for the person I am empathising with. I used to think empathy was about finding something in common with the person that we can both relate to and talking about that because that’s how it looks like to me when I observe empathy in the general population. But that can feel very invalidating for the person and is as if I am hijacking their emotional situation, or attention seeking, or making it all about me. I try and avoid that, but it is a difficult balancing act that I frequently get wrong. For the people that know me, it doesn’t matter. They understand that my intentions are good and about being caring, but my actions may appear random, blunt or insensitive. It’s no big deal to them but it holds me back from interacting more with others because of my fear of getting it wrong and being misunderstood. Empathy is extremely complex and difficult to get correct.
There is a place for the “things we’ve got in common” aspect of empathy and this blog will invite the reader to look at autism from that perspective. I respectfully ask that if the reader is not autistic they don’t assume that because we have things in common we must all be “a little bit on the spectrum”. Try and appreciate the complexities and fundamental differences behind the diagnosis. My husband has backache at the moment and is feeling tired, he is not however pregnant. Or even a “bit” pregnant! The important message I would like to share is that fundamentally there is one thing we have in common regardless of our neurology – and that is our humanity.
I like things to be predictable. In fact my husband frequently tells me that I must stop trying to second guess everything all the time. Clearly he doesn’t appreciate the total carnage that would occur if I were to do that! I have to know what is going to happen so that I can plan. If I don’t then how can I ever know what it is I am meant to do? Anything could happen! In fact, my husband is fantastic and he knows that in my unfiltered world I need some predictability and routine to guide me. We have a calendar on the wall and a magnetic planner on the fridge. They have appointments and anniversaries recorded on them. There is additional information at the moment about our lunch and dinner menu. Outside of this self-isolation period, I would not need this level of detail about our meals. I know that my husband will have something prepared for us that we enjoy – and the fact that we always have breakfast, lunch and dinner is enough information for me. But at the moment, in these times of uncertainty, I need to know that lunch is a veggie sausage roll and salad and tonight we are having spaghetti bolognese, followed by strawberries and yoghurt. Breakfast doesn’t need to be written up. Breakfast is easy. It is always crunchy nut cornflakes for me, after all, how could I possibly know the day was underway unless I had my daily fix? I describe my anxiety around the panic buying in my earlier blog about anxiety and coronavirus, and elaborate on the value of routine in my other blogs too. Our son felt much better about life once he had replaced his old pre-coronavirus routine with a new one – this is shared in my blog about coping well and self-care.
My need for doing things a particular way that is planned and organised has been called many things:
• Control freak • Highly organised (when it makes sense to others) • Highly disorganised (when it only makes sense to me!) • Inflexible • Procedure led • Consistent • Rigid • Insensitive • Thorough • Diligent
As you can see, interpretation of why I do things the way I do is open to whichever agenda or opinion you wish to hold. I can appear to be all of these things. I can actually be all of these things – and none of them – and they vary as well. Even though I love a rule and would categorise and break everything down into its tiniest elements if I could, I have to accept that human beings do things for a number of different reasons and these reasons are not fixed across one person, let alone across the entire human race. Me included.
The more unpredictable a situation is then the more people will create a routine so that there is some predictability. I loved reading survival books when I was young. All about how to live off the land after a plane crash with only a small tin containing a magnetised needle, a coil of wire, a match (with the end dipped in wax to keep it dry) and some other handy items. I also know which bear to run away from and which to make yourself look big in front of! I know how to turn urine into fresh water and how to skin a rabbit that I have caught in a noose (using that handy bit of wire). All of this has been completely and utterly useless in my life – particularly as a vegetarian. I should have studied books on how not to get bullied, not be so gullible and how to make friends! However, I do know that in a survival situation it is important to structure your day. Shipwreck survivors are likely to have created themselves a routine and stuck to it rigidly, even through the days of dark depression and flagging motivation. The world feels very frightening to people at the moment and the language and media coverage used to share information about the coronavirus pandemic often conveys fear. Every day can feel like a survival mission for some people. When you consider the difficulties of sensory processing and add to that the particular way imagination works for a lot of autistic people then it begins to make sense why autistic people experience so much anxiety.
Another way that people create predictability is by their behaviour. Sometimes I will plan and structure my outside world to give me a sense of order and control and sometimes I will provide my own internal predictability. This is important to me because I don’t have a great sense of what is going on inside of my body due to poor interoception and I have terrible proprioception as well, which results in countless bruises that I don’t remember getting from where I have misjudged doorways or fallen over my own feet.
I took my son to a trampoline park last month. We both enjoy a good bounce and he challenged me to a jousting duel on the balance beam above a pit of foam. I was wearing black socks and I stepped confidently up onto the black beam and held my pugil stick ready in my best jousting pose. My son approached from his end of the beam and all of a sudden I realised I was absolutely frozen solid. I had taken my glasses off for safety reasons and I could no longer see my black socks on the black beam and although I knew my feet were down there somewhere, I could not make them move despite shouting at them silently inside my head to move forwards or back. There was nothing more I could do. I had to suffer the humiliation of asking a teenage lad to knock me off the beam where I was stuck and into the pit of foam so that I could crawl out!
This experience made me realise how easy it is to misinterpret the actions of autistic people and it reminded me of a training session I attended where my partner said I was refusing to take part in a particular activity. In fact I was unable to despite my best efforts. The task involved using a mirror to complete a simple drawing exercise and in the same way as I couldn’t move those feet of mine because I couldn’t see them and therefore had no sense of where they were, I couldn’t make my hand draw when I could only see it in the mirror. I find mirrors and videos of myself extremely distressing. I have absolutely no sense whatsoever that the person I am looking at is me. I have been looking at some old photos recently and trying to make myself connect in some way with that person in the picture. It is difficult. My inability to recognise myself and move my body or “comply” as so many professionals like to call it can look like I am being lots of other negative words like “uncooperative” or “refusing”. It makes it seem like a choice when it isn’t. It adds a label to a person that does them no favours and offers no help or understanding.
Now that you have a deeper understanding of what it is like living in my body, you may understand why it can feel so reassuring to create predictable and repetitive sensations. There are as many reasons for this as there are for my need for external routines, and they vary in a similar way too. People sometimes use the word “stimming”. It’s not a word I like because it makes something that is so central to who I am (yet keep more hidden than almost anything else I do) feel pathologised and a symptom of something that is wrong with me. I feel ashamed of myself both for doing this in the first place and feeling like this about it, but I have a deep respect for the people who are confident in their openness and ease at being themselves. I would like to live in a world where one day a person flapping their hands in excitement or to relax is seen as normal. Self-stimulatory behaviour as it is sometimes known can be many things including:
• Hand flapping • Jumping • Twirling things • Making favourite noises • Stroking fabrics or textures • Sniffing objects • Listening to a repeated noise
There are as many of these as there are people and the purpose of stimming can be to relax, to liven myself up, to feel good, to calm myself down, to help myself think, to give myself a sense of familiarity and control. It is a need that I have and not something I have a choice over. I don’t view it as a problem that I should give up. I don’t have any repetitive behaviours that are harmful to me (unless you count getting your head kicked in for looking weird!) and if I did or if our son did we would try and change them into something less harmful, but I would never try and stop something that is integral to being me or anyone else. Repetitive behaviours are likely to be increasing across society during this time of uncertainty. Maybe the reader has their own examples? Perhaps you are nervously tapping your leg up and down more at the moment? Or smoking more? Or biting your nails? Maybe that relaxing bath with the essential oils every evening is vital for your wellbeing? Perhaps you’ve taken up knitting again and find the repeated motion of the needles and the sound of them clicking together rhythmically is soothing? Don’t be surprised if your autistic friends, colleagues and family members feel the same and please don’t jump to the conclusion that an increase in repetitive behaviours always means that something is wrong with them. There is something wrong at the moment – the Covid-19 pandemic – and it feels perfectly rational to me to increase my coping strategies because of that. I have a huge selection of coping strategies at my disposal and I try and use the healthier ones.
I have a tendency to take things literally and for me, this is nothing to do with a lack of ability to understand information. I’ll share a piece I wrote recently that describes how this works for me and is pertinent to the current world situation.
So with all this fear, why am I enjoying the social isolation so much? I see inspirational quotes on social media about how we’ll all one day be able to hug in the streets, meet for coffee and engage in small talk yet again. This is not inspirational for me. In fact, if you asked me to describe what a really bad day was like, then those three things would be in there, and pretty near the top! But I am enjoying socialising online and I have been in contact with old friends that I’d lost touch with and I’ve even been on the phone. Yes really. Did you know that you can actually speak with people out loud down a phone and they will talk back? It’s not just for using as a diary and handy internet search tool. I am realising that I am far more sociable than I ever imagined. The threat of having to meet face to face has been completely removed and I am free to communicate from another room! Let me explain why this feels so great:
I like people. I find them interesting. However, (and please reflect on the earlier part of this blog and how my senses work and how I have no filters and a tendency towards a literal interpretation of events, before you take this personally and pass judgment) – people are overwhelming.
Imagine yourself in an empty room with nothing going on. Gradually, people enter the room. It may not bother you, but try and think about it through my senses.
People smell. Every single one of us has our own smell and many people top that off with fragrances too. Imagine all that mixing together and having to be processed. This processing alone will use up some of your capacity to function. Have you ever tried concentrating when there is an unpleasant smell in the room?
People are noisy. Laughter and shouting feel the same to some people – e.g. frightening. All the noises combine and it is difficult to know which you should be paying attention to. So on top of processing the smells, you now have to calm yourself from feeling scared because of the noise and work out what to tune in to.
People move about and are unpredictable. They touch you out of friendship and to build rapport but that hand reaching out may feel uncomfortably gentle and tickly but if you flinch you will look rude so you have to switch a bit of yourself off to cope with the potential touch. So you reduce your capacity for socialising even further by switching a bit of yourself off.
…Another bit of you is processing the smells. Another bit of your capacity is calming yourself down because of the noise. That bit is also saying to you that you must act “normal” and not do anything too autistic to cope with all this like flap your hands about. You are also trying to listen to the correct conversation.
Then the person makes eye contact with you. This feels physically painful and you feel nauseous and panicky. You know that eye contact is normal so you have to use a bit of your capacity to make sure you are doing enough eye contact, at the right intervals and for the right duration. It would be easier not to but that feels rude. Think for a minute about a scenario at a job interview, for instance. Imagine being asked a difficult question that requires thinking. Where do your eyes go? Most people’s eyes will move from eye contact and turn to look slightly upwards and away from the person (or downwards and away from the person if they are feeling intimidated or told off). It frees up some capacity to think.
I haven’t even covered all the senses yet but am conscious of being repetitive. Now add in some factors like taking things literally and struggling to know how you feel or how to show empathy appropriately.
I hope this has shared my experience and helped make a point without being too preachy. My avoidance of social situations is nothing to do with liking people or being aloof. My outward expression because of my poor interoception may make me appear to be disinterested or bored or unemotional but that is not the case. I avoid social contact because it is so bloody exhausting!
What I have found is that this reduction in social overwhelm has increased my usually overloaded capacity. I am able to relax and enjoy things and my focus has been intense and productive. I also know that I am good in a crisis. A line manager once said to me “I do believe you thrive in a crisis” and she was right. When others are reacting emotionally, I am calm and logical and continually seeking a practical solution. Sometimes this is annoying for people. Sometimes people don’t want me to solve their problems, what they want is a listening ear and a person to just sit near them that they can share it with and I am very good at getting this wrong and defaulting to being helpful and trying to fix things. At the moment though, my traits of being calm, following instructions and being able to hyper focus are useful and valuable. Some of my most commercially successful work has been done at times other people would have taken off for compassionate leave. Having a focus gives me a purpose and it regulates me because I know what it is I am meant to be doing. It channels my energy. I was told once that I should take it easy at times of high stress. This was said by a mental health professional that was viewing my undiagnosed autism as a psychiatric illness. This is good advice for some people but not for me. There is always a balance to be found though between focus, interest and obsession. I explored the benefits of seeking information in order to cope with situations in an earlier blog and noted that it is important not to become obsessed. Here are some tips:
Self-care and regulating myself is part of my daily routine. It consists of activities likes walks and exercise and meditation sessions but mostly from integrating self-care as a way of doing things rather than a special activity I have to plan. This is much better for me because if you do things mindfully, for instance, you don’t have to find time for a mindfulness session. I’m more likely to stick at things and remember to do them. My hobbies are important at the moment and I am delighted to see that it is becoming “normal” again to have hobbies. Years ago, people would ask each other what their hobbies were and they’d take pride in them. They weren’t always competitive things but were activities that provided a focus and brought enjoyment to the person. Hobbies have gone out of fashion in mainstream society but autistic people frequently have hobbies. Sometimes this is pathologised in my personal opinion, and is referred to as a “Special Interest”. I have friends who are comfortable and proud of the “Special Interests” label and they quite rightly say that their special interest is far more than a hobby. It is something they have an intense and deep knowledge about, something that brings them far more pleasure and satisfaction than the hobbies people tend to have does. I agree with them on that and to call their interest a hobby would be disrespectful and invalidate the importance of it to them or their incredible levels of knowledge, commitment and skill. This is the great thing about people though. We can disagree on things. I am totally cool with calling my friend’s special interest a special interest and she calls mine a hobby. There is no right or wrong and we both know what we mean.
What is important is that everyone can benefit from finding an interest or hobby. It gives a break from the day to day mundane parts of life. It provides respite from the stresses and strains going on around us. It enables us to put our energy somewhere productive and creative. My hobbies are fairly mainstream and this is not uncommon in girls and women who have autism. We tend to be more affected by social pressures and choose to pursue interests that don’t make us stand out any more than we already do. What I will say is, enjoy your hobbies and take an example from those unconventional people in society – autistic or not. I’m pretty mainstream with my hobbies compared to some people but still a little unconventional. Do whatever it is that brings you joy. If your interest is motorbikes and you’re a woman then so what! If you have a secret stash of animal bones in your garden that your husband doesn’t know about (oops! until now), then who cares!
These are strange times. People keep telling me this. They are right.
I feel fear of the unknown everyday because I am autistic. I crave predictability and feel stressed when my routine changes. I want to understand everything I can so that I feel in control, but there are some things that need more than an explanation to sort them out. I crave solitude and time on my own so that I can have a break from the overwhelming world. So please don’t feel sorry for me sat on my own or when I turn down an office party – I like being like this and I don’t want to be more sociable, it’s ok and I am alone but certainly not lonely.
There are valuable lessons to be learned from each other and I include all people in this – of every neurology, gender, sexuality, race, age or IQ. I secretly (well not so secretly now!) hope that many of the quietened voices in society will be heard during this time of reduced social contact. Those people that don’t thrive in a busy, social world; those people that are problem solvers every day of their lives; the innovative thinkers; the ones who find simple pleasures in life with total disregard for perceived status; the ones who aren’t heard because their voice isn’t communicated through speech or people simply don’t listen to them. If we are going to make a better world through this crisis then lets make sure everyone is enabled to play a part in it this time.
“Mummy, I’m happier now I’ve got a new routine”. This is a relief for us all in our family. We are no different to any other family at the moment coping with these strange and uncertain times. Some of our challenges may feel a bit quirky, unusual or just plain selfish to other people but they are our reality in the same way that every single individual, couple and family will be having their own unique set of challenges at the moment.
We were eating our Sunday dinner. This was important. My husband had cooked a favourite roast meal for us, the same as on any other typical Sunday. I made sure that my veggie sausage acted as a gravy breakwater so that no gravy seeped on to my roast potatoes. What I would have given when I was young to have those food dividers on my plate to ensure separate foods didn’t touch! But back then when I was growing up, it was called being a “fussy eater”. My son, who is a teenager and now bigger than me; and who enjoys wrestling; cartoons that involve lots of swearing and gross-out humour; and is planning how he will attract girls by developing a muscly chest and holding our cute dog in a photograph for his tiktok account (I kid you not!) has mashed potato not roast. And it is lovingly crafted into the shape of a steam ship by my husband – complete with upright sausage funnel. This familiarity brings us pleasure and reassurance. Even the dog is happy, she recognises Sunday by all the visual, scent and auditory cues that go with our weekly roast dinner and she’s eyeing up her bowl in readiness for some leftover veg. If our son settles down with a partner when he is older, I hope they have skills in making sausage and mash steam ships!
Our son announced to us that he was happy because he has a new routine now. He listed his routine and although it didn’t sound that educational, healthy or varied, it was a good solid routine that would fit into these strange times and add some predictability and control for him. It is like this:
Watch a cartoon
Play video games
Go outside for the afternoon
Watch YouTube videos
Watch a comedy programme or a car programme
Bedtime story with dad
In fact, it is a fantastic routine because he has created it himself and we can add in various bits and pieces to his day that won’t upset the routine but will add variety and balance. For instance, the YouTube video watching time can be used to slip in something educational. The video games time can be spent online gaming with friends – including old friends he has lost contact with. The outdoor time can be used for all manner of activities that will promote exercise and wellbeing.
Before this new routine had become set in our son’s day, he was extremely restless and although I feel I shouldn’t say it; demanding. He cannot initiate activities for himself and it was an endless “mummy” (said in a very particular tone that consists of 4 syllables and a whine) “what shall I do now?”. This was mostly because he did not know what to do but also because he freely admits he likes saying “mummy” like that. He tells me that he finds the sensation in his mouth and ears very satisfying. It probably also creates a stronger reaction in me than his normal chatter if I’m honest, and as someone who is not particularly demonstrative or outwardly emotional, he possibly enjoys seeing my lack of patience escalate whilst I am trying to look calm and normal! Of course, getting fantastic sensory feedback from certain sensations can be very stimulating and if you repeat them endlessly it can create its own sense of calm, predictability and control – and just plain, feel nice – which is important to remember during these times where so much doesn’t feel nice because of the anxiety whirling through society. I am sure an increase in repetitive behaviours is a fact of life for many autistic people at the moment. His new routine hasn’t stopped him asking questions or seeking reassurance about what is happening or needing prompts for what to do next but it has helped him feel slightly calmer and helped us as parents understand him better which means we can respond in a more helpful way. It means we can concentrate more on our own self care which is vital, particularly when you are all under one roof. I need to wind down at the same time as our son winds up in the evenings and this can create quite spectacular meltdowns from us all if not anticipated and proactively managed. I’m not saying it will avoid overload or overwhelm but it has reduced the impact of it.
My own anxiety about the uncertainties has increased too and of course my autism is affecting how this looks and feels. I imagine I have the same anxieties as the rest of society about getting ill and seeing loved ones get ill. And the whole, massive, almost infinite box of “what ifs?” and “whys?” that is sitting directly above my head, drip feeding my brain at the moment. My routine hasn’t changed much and some pressures have been reduced because I thrive on working from home and my job is safe, my employers are fantastic and I have a valued and important job that is enabling me to focus my coronavirus anxieties and the need to plan, control and understand what is going on into something positive, useful and beneficial. It also means I can leave Covid-19 at the metaphorical office door when I finish work and I can focus on other things.
It is important for me to have breaks from interests and I crave balance in my life constantly because I know it benefits me. I have a tendency to hyper focus and fixate on things to the point of obsession and this can be detrimental to my wellbeing so I need to compartmentalise things so that they don’t take over. “Broad rather than deep” is my mantra at the moment. Although I readily admit that my ‘normal’ depth is probably deeper than most people’s – I can’t just let it lie, I have to explore, find out and see how everything works. I can hear my mum’s voice berating me “you have to fiddle with everything don’t you, why can’t you just leave it alone instead of taking it apart and breaking it?!” I have always been an analyser.
Social distancing. I had never heard of this phrase two weeks ago, but I am loving the experience. I am absolutely not being facetious about this. I have been more sociable than ever before. I have reconnected with old friends, colleagues and acquaintances and I’m enjoying the online contact with them. What makes this work is that there is no expectation that we will have to meet face to face. I avoid friendships and going out in groups because I find it so painful not knowing what to do and say and it reminds me that I am different – and that reminds me of every negative experience I have ever had of being weird, different and an easy target for bullies or teasing.
Our son is from a very different generation. Differences are more accepted and he has grown up with ‘different being normal’ in our family. He is far more self-assured than I am and he is missing his friends and the face to face contact and being able to run around with them and play fight and hit each other and muck about and wrestle them. Strong proprioceptive input is important for his sensory regulation and although I am a middle aged woman and smaller than my son and therefore not a good wrestling partner – particularly if you take into account my accident proneness – we need to find time for lots of strong hugs and squeezes and physical work like digging the garden and moving firewood and bouncing around on a gym ball. He also misses talking with his friends and the PlayStation is a wonderful tool at the moment because he can play online, (combat games mostly) and pop his headset on and talk to them. It does make the house feel rather small though with his put-on Cockney accent shouting orders at his platoon to take down enemy troops!
Education can wait. It can be done by stealth. Sneak in an educational YouTube video; strike up an interesting and informed discussion or debate about sociology, politics and the media – there is after all a wealth of information out there ripe for discussion. The biggest lesson I hope he learns from this is how to develop resilience and good coping skills. I wasn’t taught these and I didn’t learn them myself from watching others. What I did learn as a child about coping was not always the healthiest or safest ways to get by and has cost me deeply in wasted years where I no longer thrived and in ‘treatment’ and therapy to put things right. It was far easier to rebalance my missed education. School was not a good place for me and in terms of exam results I certainly ‘failed’ even though my attendance levels were high and I did not miss time because of a pandemic. When the time was right I completed a Masters degree and I have just written out my proposal for the PhD I am going to undertake. It was relatively easy to achieve with hard work and the right sensory environment for studying in. What was much harder to rebalance and is a daily effort on my part is my mental wellbeing.
Self-care through these times is essential and I hope we can make a better, fairer, kinder society because of this pandemic. Even if we can’t, the most important thing for our family at the moment is being together, reflecting on what is important to us and for us and helping each other cope. That is the thing we can influence. We cannot make politicians see sense, we cannot make people follow advice, we cannot learn everything there is to know about immunology and virology and medicine and even if we did it may not change anything. But we can take our time, take stock of who we are and create new routines that work and demonstrate how important it is to take care of ourselves. From that, good coping skills and resilience will come and that will be a more useful lesson in life than doing sums or history lessons.