Difficult Discussions: Where autism meets mental health

Tomorrow, as I publish this, is World Mental Health Day.

I’m not paticulary one for new years resolutions but the two I always make are a promise to talk to people more – seeing what I can learn be that from a colleague or a friend, and to keep check of my mental health. This year has not made either of those easy, and look, despite the urge to say ‘things are okay’, Its equally fine to admit that they are not.

Though, this is not another post about the pandemic. Its about understanding the connection between mental health and autism. Up to 70% of autisitc people experience mental health issues such as anxiety and depression. While I have never been diagnosed with any mental health conditions, I quite often feel a lingering sense of anxiety, and alongside that a lack of confidence in myself which only subsides at times where I’m comfortable in my routines and understanding of the world. We don’t know exactly what’s responsible for the prevalence of these difficulties in people on the spectrum. That said, there is research to indicate that a feeling of autism not being accepted as a positive aspect of ones personality leads to feelings of alienatiation.

I’m conscious of the way my autism marks me out as different both outwardly through affecting things like my speech, reactions and coordination and inwardly by impacting my ability to process multiple sensory stimuli at once, making me quite emotionally vulnerable. All these can show in social situations and therefore having my autism accepted is important to me. I have been in situations where I feel some of these aspects have ostracized me, making me feel somewhat depressed.

As human beings we have a natural desire to be accepted and to belong to a group. For autistic people, this presents a dichotomy where we can either disclose our autism and risk having it met blankly, or put on a façade of ‘normalcy’ and risk appearing strange to other people if we don’t ‘camaflagoue’ effectively. Both these forms of lack of acceptance can be harmful to an autistic persons mental wellbeing.

Interacting with emotion

One of the main challenges in confronting mental health difficulties and autism is deciphering the difference between the symptoms of anxiety and depression, and those of autism…

Take socializing. How do you distinguish between someone with no interest in social interaction and someone who who is incredibly socially anxious? And is it fear of ridicule thats driving that, or a generalized ‘irrational’ fear of talking to people? One of my special interests has always been in media. I’ve always admired journalists and creators, like those who investigated the Cambridge Analytica scandal and music journalists who have built up a reputation as freelancers. In uni I was understandably told I needed to be at all the cultural events, asking questions, reporting on social media, pushing myself to the forefront of the public eye. I’m getting far better at networking although its by no means easy, and while I took great pride in my special interest, I remember metaphorically beating myself up over the fact that I didn’t think of myself as confident or ‘savvy’ enough. I very much had and have a lasting uncertainty about the way my occasional lack of confidence would effect me in life.

I do certainly have a need to be on my own at times. That said, I don’t have any trauma from past attempts to socialize, which puts me in a semantic quandary, as only that would technically qualify as ‘anxiety’. The problem is that we’re thinking about the problem through a limiting lens. There is now more work being done on how autistic people experience mental health difficulties. Psychologists have started looking at ASD specific difficulties including factors such as fear of the uncertain, and a more general fear of communication. One interpretation of what I went through might be that my special interest turned into a constant source of fear or worry where I feared the consequences of what would happen if I didn’t live up to my own expectations; I prefer to think of the experience as a fear and difficulty in working out ‘what comes next’ contributing to those feelings of anxiety and worthlessness.

Still, why is it that these feelings are so inescapable for a lot of people on the spectrum? I do worry more than I should – usually about trivial matters. In fact, many autistic people report the same sense of lingering anxiety, often over something as benign as a pain in thier arm or how they organise thier day. This perception of the world as overwhelming might be down to the fact that autistic people sometimes overlook certain cues leading up to an unexpected experience, and that this exacerbates anxiety and sensory overload. I know there are environments and circumstances which I consider ‘safe spaces’, and that outside of them, I feel very anxious and afraid. While the facts around this are up for debate, there is some sound research and logic to support the idea. That said, given autism and mental health are on a spectrum, it would be a mistake to group the symptoms of both in together into one umbrella theory.

The consuming nature of how your mental health treats you, often makes you feel like no explanation can quantify how your feeling. I have states where my happiness is so overwhelming that the last thing I want is logic to come along and ruin my positivity, just as I’m sometimes in a state where even the idea that what I’m going through has a rational explanation, fills me with dread. That’s what this next section will look at.

Taking off the Mask

Lets return to this idea of distinguishing between a difficulty with mental health and a symptom of autism.

Going through a dark patch in your mental health seeps the life from you. However long it lasts, time seems to drag while its going on. You feel either a sense of worthlessness in yourself and your achievements accompanied by a sort of bleak negativity in everything around you, or a constant uncertainty in your actions which makes you procrastinate, worrying that everything you do is wrong or of no use to anybody. Physically, these sensations are met with extreme tiredness or aching.

I might call these patches autistic burnout or depressive episodes. However, I see both as interlinked. I’ve described before how I’m emotionally sensitive. So, something as small as a mean comment or a huge disappointment can impact me, messing me up mentally or bringing down my mood for perhaps a whole day. Another potentially harmful stage is the process of ‘biting my lip’ and muddling through, while trying to maintain a somewhat positive façade. This exhausts mental energy which further saps my ability to interact and communicate, all of which has the potential to create a rather vicious cycle of poor mental health.

Thankfully its not all negative. I have built up a level of awareness that allows me to realise when I’m going through a dark patch in my mental health and stop it spiraling into something bigger by seeking emotional support and trying to understand how I’m feeling through documenting my experiences. That’s not to say that everybody can do that. I realise that getting out of that cycle is difficult. In the period between leaving university and initially struggling to find work, my stagnant position led to a self-fulfilling feeling of hopelessness, which undermined my health both physically and mentally.

On a wider scale, this has serious effects. Autistic people are four times more likely than neurotypicals to experience feelings of dejection, insignificance and depression. This can severely impact even our previously learned independence skills. I know from experience, that not getting the opportunity to socially interact, makes my confidence plummet. It also warrants pointing out that autistic people are at alarmingly high risk of suicidality. I’ve been lucky enough never to have been in that frame of mind, even though I’m conscious of anybody’s potential to feel like that at some point in thier life. I’m also paticulary moved by the stories of those autistic people close to me, who have been through that degrading and awful mindset.

“People with autism often struggle to imagine the thoughts and feelings of others, including their own future selves. As a result, they may have trouble believing they will ever feel better. They can also easily become overwhelmed by the small but complex problems of everyday life and respond with extreme thoughts or statements”

Sara Deweert, Spectrum news

I had to include that quote as its so accurate, to the way I and many others have felt. When your emotionally hurting, one of the irrational questions that rears its head is ‘am I going to feel like this forever?’, and thats a scary mindset to get stuck in. I’ve never been very good at solutions, but the one thing I will ask you to do if you know somebody suffering with mental health difficulties or you think theres a possibility that somebody might be, is to show compassion. Just as a negative experience such as the pandemic can embed us in ways of thinking which feel inescapable, something as simple as a kind message from a friend can remind us of all those times when we’ve felt positive and that we will feel that way again. Remind somebody of that, this mental health day.

An Atypical Perspective…

Autistics experience mental health in different ways: We cannot look at mental health in autistic people through a purely neurotypical lens. While many peoples struggles to socially interact might be offset by past experience, many of us just feel naturally socially anxious. Whereas most have the ability to process changes in thier environment or circumstances quickly, our ability to understand and comprehend these changes may be severely impaired. Importantly, through the process of masking and wondering whether or not to disclose, we exhaust a large amount of mental energy which could be better spent. Obviously everyone’s mental health difficulties deserve attention, and nobody is more important than anybody else, but not everybody experiences thier mind in the same way. Realising that is surely a vital stepping stone in the pathway towards supporting individuals, over stereotypes.

Mental Health States can be consuming (and thats okay): As always, I can only speak for myself here but I know as an autistic person who is conscious of thier mental health, I can be overwhelmingly happy at times and utterly miserable at others. Its only in those two extremes that I can fully decipher how I’m feeling. When you occupy either of those mindframes, it colours every other aspect of your life, making you unable to see past your current emotion. Especially in negative mental states, its important to hold on to the knowledge that things are rarely that black and white and that the sensation your feeling is not inescapable, even if that does seem like more of an uncomfortable truth than something thats wholly reassuring. Through having that reassurance, we can realise that our mindsets are temporary and seek to understand why we’re feeling that way.

Compassion is aspirational: The simple act of sending a kind message to a friend is the baseline level of compassion and is definitely an amazing behaviour. However, compassion on a grander scale is worth aspiring towards. I’ve been trying to make myself and others feel better by reaching out to people I haven’t spoken to in a while and making plans to see them when conditions allow. In the long run, I’d like the current pandemic to result in more community initiatives to help the most vulnerable, every workplace becoming somewhere where people can feel mentally reassured, and mental health facilities expanded to reflect the wide array of experiences people have. While building fully compassionate societies cannot be achieved overnight, as a goal it provides a blueprint for making the spaces we interact in receptive to the needs of autistic people and all those struggling with thier own mental state.

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