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Autism

In the August edition of The Psychologist an article discussing autism in women quoted Margaret Atwood’s ‘The Penelopiad’ to encourage those diagnosed with autism to not let their challenges stand in the way of them fulfilling whatever they want to do, which I liked:

“Water always goes where it wants to go, and nothing in the end can stand against it. Water is patient. Dripping water wears away at stone. Remember that, my child. Remember you are half water. If you can’t go through an obstacle, go around it. Water does”.

This is cited to highlight how with autism if you cannot go the neurotypjcal route, find your own route. Understand that your obsessive attention to detail is a great strength that will enable you to excel at many things. But also understand your challenges as this will help you to mitigate them, so that they don’t have to stand in the way of your future. I worked with someone diagnosed with autism who  thought speaking in public would be impossible due to her difficulty with social interactions and communicating and having been told so often what she could and couldn’t do. However, she presented at a conference and captivated the audience, something that she never thought she was capable of and I certainly could not have done. Eloise Stark, the author of the article mentioned above also described how she will strive to become a clinical psychologist despite people’s beliefs about her ability for social skills and Theory of Mind and I hope this acts as motivation and inspiration to others.

Take autistic inertia, this is resistance to change in state, so starting something or stopping something. This is core to the difficulties that people with autism face, but as Fergus Murray highlights in his support for the theory of monotropism in autism, it’s also immensely valuable. Similarly, the description of ‘restricted interests’ is often used, but taking the stance of monotropism that rests on the idea of an ‘interest system’, we are all interested in things which help to direct our attention and certain interests will be more or less salient at different times. In a monotropic autistic mind, less interests are activated at one time and take more processing resources, so it is difficult to cope with things outside of where the attention is currently directed, but this can be seen as ‘focused interests’. It is true that autistic individuals are strongly pulled by their interests compared with most people, but just because one cannot fathom their failure to be interested in things that are similar to or important to one’s own interests, doesn’t mean that they should be called ‘restricted interests’. This is a huge asset in so many fields where intense focus is indispensable – maths, science, technology, philosophy, music etc and workplaces and schools should facilitate this being celebrated and meet each individual where they are at and explore, engage with and harness their passions, rather that just trying to pull the individual out of what’s important to them. It’s important not to pathologise ‘special interests’ and much of autistic behaviour is an attempt to bring back equilibrium. Needing stability is vital in autism as not feeling understood,  being surprised by the actions of others’, being monotropic in a polytropic environment, and being pulled out of an attention tunnel is severely destabilising. As such, maintaining stability, enabling a sense of being in control which self-orchestrated routines often assist and minimising mental overload is key.

 

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Albert Einstein

“A person who never made a mistake never tried anything new”

The more you try and experience, the richer your life will be and yet so many people hold back from doing new things for fear of failure. Children learn by continually making mistakes and as Churchill said ““Success is going from failure to failure with no loss of enthusiasm”. You would not have been able to just jump on a bike and ride it the first time, you would have had many attempts and falls. Think of how you came to swim, read, or tie your shoes, it probably involved a lot of failed attempts and frustrations, but wasn’t it worth it? Many experiences are made in the process of such learning processes, it is not just about the end result. Yet as we get older we expect to just be good at things immediately. So often people put pressure on themselves to make all the correct decisions and turns and there is a real sense of finality having done this. Instead of trying not to make a mistake in life, avoiding making decisions and actions, find opportunities, try new things and know that you will probably make mistakes.

“Leap, and the net will appear” (John Burroughs) – if you are waiting for the conditions to be exactly right before doing something new, then you may be waiting forever. When trying something new, you have to jump and have faith that you will land safely. What mostly happens is once you take the leap and find yourself in a new situation/experience, possibilities and options arise that you could not have foreseen and that might not have presented themselves had you stayed safely on familiar soil. That is the danger of overthinking and overplanning decisions, as we cannot predict such things. Things often seem impossible until they are done and it can be useful to recall a time when you thought something was impossible at first and yet you managed to complete it.

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Dolly Alderton – Everything I know about love

This is a book that I never expected myself to buy or enjoy, but looking for an easy holiday read I was pleasantly surprised. I think this book beautifully describes the power of female friendships, but is a good book for those going through the transition period between school – university – work and perhaps have got caught up in a party lifestyle, but are realising that this is becoming destructive and is beginning to take a toll on other areas of one’s life and also to help take the world of dating in a lighthearted way. There were a few other things that I think she articulated particularly well:

Discussing the complex nature of recovery in eating difficulties:

“As I got older and mercifully more aware of what a precious gift a healthy working body is, I felt ashamed and bewildered that I could have treated mine so badly. But it would be a lie to say I think I will ever be entirely free of what happened in that time, which is something no one ever tells you. You can restore your physical being to health; you can develop a rational, balanced, caring attitude to weight as well as good daily habits. But you can’t’ forget how many calories are in a boiled egg or how many steps burn how many calories. You can’t forget what exact weight you were every week of every month that made up that time. You can try as hard as you can  to block it out; but sometimes, on very difficult days; it feels like you’ll never be as euphoric as that ten-year-old licking lurid jam off her fingertips, not ever again.”

Realising that alcohol can be used to fill a void, an empty daytime life and is not as frivolous and fun as it may seem at first glance. It can numb pain or distract temporarily, but those things don’t go away and are likely to become more painful when you stop drinking and have to face up to them:

“Life grew fuller in the daylight hours and there was less need to escape at night. But it would still take me some times to realize that the route to adventure doesn’t’ just involve late nights…I always saw alcohol as the transportation to experience, but as I went through my twenties I understood it had the same power to stunt experience as it did to exacerbate it.” (p118)

She describes the feeling of walking around in a world where you think someone is about to tell you something terrible that you did last night and you are ready to agree with them, assuming the worst of yourself and trusting them over your recollection – as she says what sort of fun is this really?

“Be the person you wish you could be, not the person you feel you are doomed to be. Let yourself run away with your feelings. You were made so that someone could love you. Let them love you.”

“I tried to put a stop to people-pleasing, aware that giving my energy and time away so freely was what was chipping away at the void that I didn’t want to turn into a quarry. I was more honest; I told people when I was upset or offended or angry and valued the sense of calm that came with integrity, paid with the small price of an uncomfortable conversation.”

So often we think we can and should only rely on ourselves and suffer alone, but we are relational beings so let others support you:

“I was reminded of the chain of support that keeps a sufferer afloat – the person in the core of a crisis needs the support of their family and their friends, while those people need support from friends, partners and family. Then even those people twice removed might need to talk to someone  about it too. It takes a village to mend a broken heart.”

How we so often become disconnected to ourselves:

“The child that is told not to show off or not to be a clever-clogs puts up barriers around certain recesses of who we are; and  we’re scared to ever revisit them again as adults. Instead, we hide these parts of ourselves. The bits that are dark or loud or eccentric or twisted, for fear of not being liked. It was these parts of ourselves, he argued, that were the most beautiful”.

An important realisation – Anyone can be fancied, it is much harder to be loved

A common mistake – Don’t confuse intensity for intimacy in relationships

Finally, we so often put immense pressure on romantic love, however as a consequence of this we can often overlook how much love already surrounds us – in friends, family, community, things that have been given to us with love that might be filling your room and some of the stories behind how we came to be who we are and what we do or have.

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Ageing and the passage of time

In The Bell Jar published when Sylvia Plath was 29, she described time passing as the complex and overwhelming array of branches:

“I saw my life branching out before me like the green fig tree in the story. From the tip of every branch, like a fat purple fig, a wonderful future beckoned and wrinkled. One fig was a husband, and a happy home and children, and another fig was a famous poet and another fig was a brilliant professor, and another fig was Ee Gee, the amazing editor, and another fig was  Europe and Africa and South America, and another fig was Constantin and Socrates and Attila and a pack of other lovers with queer names and offbeat professions, and another fig was an Olympic lady crew champion, and beyond and above these figs were many more figs I couldn’t quite make out. I saw myself sitting in the crotch of this fig tree, starving to death, just because I couldn’t make up my mind which of the figs I would choose.”

I have noticed in therapy how often adolescents and those starting out in their careers and life are overwhelmed and paralysed by the multitude of options and choices. There is a huge concern to make the ‘right’ choice and there can be confusion in trying to decipher what they truly want to do and be, from what is expected. However, as we get older there is a sense of security that comes from having chosen a direction or path, but with every choice, with every turn chosen at a junction or cross roads, those other paths, doors and opportunities are closed. The slamming of doors with the passage of time was understood and articulated well by David Foster Wallace. At age 33 he wrote:

“Day to day I have to make all sorts of choices about what is good and important and fun, and then I have to live with the forfeiture of all the other options those choices foreclose. And I’m starting to see how as time gains momentum my choices will narrow and their foreclosures multiply exponentially until I arrive at some point on some branch of all life’s sumptuous branching complexity at which I am finally locked in and stuck on one path and time speeds me through stages of stasis and atrophy and decay until I go down for the third time, all struggle for naught, drowned by time”.

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Traumatic Memories

“Stressful experiences such as childhood sexual abuse are so overwhelming and traumatic that the memories hide like shadows in the brain” (Paola Borella).

Bessel van der Kolk is a prime advocate of the idea of body memories – the body remembers what the mind forgets. He along with many others propose that traumatic memories are not integrated and so are not so much remembered, but relived. Often trauma survivors will present in therapy as being very cut off from their bodies and body work and yoga is an important start to encourage people to feel safe enough to experience sensations in the body. Often one of the final stages of trauma work is being able to really be in your body.

How are traumatic memories stored?

They are encoded differently in the brain due to the overwhelming emotional arousal and the release of stress hormones affects hippocampus memory functioning and the strength of memory consolidation. Trauma is stored in the limbic system, which is the area of the brain that processes sensations and emotions, but not language. This can explain why some trauma sufferers have implicit memories of emotions linked to the trauma, but no explicit memories. Explicit memories are stored in the hippocampus amygdala, and neocortex and implicit memories are in the cerebellum and basal ganglia. The hippocampus is responsible for organising information, but when its functioning is hindered memories cannot be organised into a whole and will be later retrieved as fragmented, isolated images, bodily sensations, sounds, smells etc. It is highly common for those who have experienced trauma to have hazy memories that might emerge later on in life. It is thought that it takes approx 20 years for repressed memories of childhood sexual abuse to resurface, and the younger the person at the time of trauma that greater likelihood of amnesia – this is functional amnesia.

van der Kolk’s client did not have any memory of being involved in a nightclub fire, but on the anniversary of the event she kept re-enacting her experience. Dissociation is a very common way of coping in response to sexual abuse as it is an out of body experience. It disrupts the storage and retrieval of memories and can explain why people have gaps in their memory.

But all these changes in the brain are reversible – with an enlarged hippocampus then one can more readily overcome fear responses and store and recall memories more easily.

Working with traumatic memories

It is important that distinctions are made between current stresses and past trauma to avoid feeling re-traumatised by triggers. – identifying triggers and then using grounding techniques to minimise their impact

When experiencing flashbacks, the flashback halting protocol devised by Babette Rothschild can be useful to help with grounding: https://makingsenseoftrauma.com/wp-content/uploads/2016/04/Flashback-Protocol.pdf

or it can be found in Rothschild, B. (2000). The body remembers: the psychophysiology of trauma and trauma treatment. New York: Norton.

Body scanning and beginning to recover memories and process them is an important part of therapy. But before one can work with traumatic memories, first of all the client has to be safe enough to do this – feeling safe in the client-therapist relationship and having a secure bond, but also having some control over their behaviours.