In an upcoming book review I talk about an autistic author’s battles with his own mental health problems. The writer, Luke Miller-Ball, details his lifelong struggles with depression and anxiety disorders. Research suggests that people on the spectrum are 40% more likely to suffer from depression or a related mental illness than those who are not on the spectrum (Depression and autism | What is autism? | Autistica | Autistica).
On the surface level, the reasons why a person on the spectrum may be more prone to depression fall into two categories. Firstly, not receiving necessary supports from work or social settings. A reason for a lack of support for an autistic person could be ignorance of their condition from colleagues and family members. They could have a predetermined idea of what an autistic person is (Dustin Hoffman in the film Rain Man or the non-verbal savant that can do really complex maths in a very quick time) and these preconceived notions mean that support is withheld as no one thinks that the support is needed.
It has been my experience that the support that has been offered tends to be targeted towards the neurotypical mind.
This is an example of Double Empathy Problem – a failure, from both sides of the fence, to adequately communicate what a person’s needs are. Communication is a two-way process and if neither side are correctly identifying what to do then this will lead to a lot of uncertainty and confusion.
Secondly, the prevalence of alexithymia can play a significant role in the development of depression. Alexithymia is, basically, emotional blindness (Alexithymia | Psychology Today). It is an inability to spot, understand and react correctly to the emotions of others, and crucially, emotions in oneself.
The Autistica study, quoted above, also suggests that a person with depression and autism may have a higher prevalence of self-harm or suicidal thoughts. This may be due to autistic people masking to hide their autistic traits and supressing how they feel in order to be accepted socially. When compared to neurotypical people with depression, this feature was far less prevalent.
My Mental Health
When I was younger, I started to suffer due to my mental health. I would often feel isolated and lonely. My brothers (one older and one younger) would always have partners, friends and things to do and I would be in the house on my own. I would, from the age of 17, drink at home watching the television or reading a book. It wasn't gallons of vodka and it was only on a weekend but, it set a pattern of me being ok to drink on my own. Which, isn't the healthiest, physically or emotionally. We would have family meals and I would be the only single one. I felt very alone despite being surrounded by family. I felt like I couldn't talk to women and I allowed that to become how I judged myself in terms of attractiveness, worthiness and deserving of anything positive. I felt like there was nothing to me, that I was a reflection of what other people expected of me. Like a dirty and smeared mirror. When I went off to university, this sense of being on the outside only got worse. I made some good friends but I don't talk to them as much as I probably ought to and I always felt like the odd one out.
I started taking anti-depressants around the age of 21 and have, with a few exceptions, been on them ever since. I was told that I had some "elements of depression". Whether or not an autism diagnosis would have made a difference at this stage, I do not know. I just remember feeling isolated, alone and like I wasn't made for this world. Every time I started a job it always felt as if I was not "meant to do" this job. Considering, I do not believe in fate or predetermination it was odd. How can I be meant to do anything if we are not meant to do anything?
I am almost certain that I have some form alexithymia. I have even confused anxiety or panic attacks for heart-burn and indigestion. When my paternal Grandfather died he had left a note. It wasn't a suicide note or anything but he knew that, due to a heart condition, he could just fall down dead. I was sat in the lounge at home and my father passed this note around. My mother, my aunt and a few others read it and welled up. I read it and felt nothing. It wasn't down to a slightly strained relationship with my grandfather or anything like that. I just read the words and felt nothing. In the moment I did wonder why this was the case, why wasn't I feeling and showing emotion the way everyone else was? I have gone to the funerals of my maternal grandparents, who I adored, and didn't tear up or really feel anything. I even winked at The Wife as I carried my grandmother into the crematorium on my shoulder.
In 2016 I discovered The Wife having a massive brain haemorrhage, she was seizing, unresponsive and foaming at the mouth, I felt calm but I wasn't. People would later say I looked terrified (gee, you think?) but I didn't overtly feel it. In the hospital, a small room full of The Wife's family and friends, a Doctor told us that yes, she had suffered a brain haemorrhage, she was in a coma and she, my better half, the mother of my child "might not wake up". I left the room and broke down. I still beat myself up about this reaction. I wasn't man enough to keep it together.
Because I am unable able to identify how I am feeling it means that I cannot recognise when I am close to burn-out or a meltdown.
If an autistic person cannot identify negative emotions within themselves then, it stands to reason that they will suffer some form of mental health issue. I cannot recognise the signs that I am falling into a bout of depression. I am extraordinarily lucky that The Wife can spot these a mile off and warns me, continuously, months in advance. I don’t, necessarily, listen to these warnings but they are there. If you apply this logic to a visible, physical illness then it is akin to not being able to spot a broken foot and then not understanding why you started to walk with a limp all of a sudden.
Panic
I have had a number of panic attacks/meltdowns since my autism diagnosis. One example was when the security alarm went off as I was leaving an Asda store. I froze, like a deer in headlights. The Wife un-phased (as she knew we hadn't stolen anything) ushered me over to the security guard. I could not find our receipt and as the security guard was patiently waiting I went into full meltdown. The world felt like it was closing in on me and that no matter how hard I searched I could not find the bit of paper that proved I had not stolen some steak. The Wife and the security guard trying to calmly sort the bags and reassure me as I threw objects all over the place. In a fog of shame and panic I shouted at The Wife, "do not try and fu**ing CBT me, I am not one of your fu**ing patients". Surprisingly, The Wife stayed around and eventually found the receipt and off we went. What led up to this? All I remember was that I had a work meeting within 40 minutes of leaving the Asda, which is a 15 minute drive from home. I was terrified that I would be late and so panicked and...made myself late.
Another time I was sat on the top of the stairs rocking backwards and forwards crunched into the foetal position. My chest crushing in on itself. I described this, to a therapist, as putting Mentos in to Diet Coke and closing the lid. A culmination of factors: work stress, home stress, money worries and a host of other things had shaken the bottle violently. It exploded and I did not know what was happening or what to do. I felt panicked. I felt, bizarrely, amorous. It was the first time in my life that I felt that I had an actual disability. It took what I thought was 30 minutes of The Wife helping me ground myself. I was surprised to find out this actually took over 2 hours.
As a person who was late diagnosed with autism then a lot of my own struggles with mental health issues could be categorised as not receiving the correct support. I was simply unaware of what support I needed because I was unaware that I needed any support. As a result, I became trapped in a, self-perceived, failure loop. I would fail to achieve what I wanted in an area of my life – academics, family, relationships, work, whatever – and so I would always expect to fail. I'd beat myself up for that failure and repeat ad infinitum. This is something I look at in my Cleaning the Chaos Cupboard post. Add to this, not being able to function as an adult (messy house, not showering as often as I should, forgetting bills and so on) and the feeling of failure is validated which only adds to the depression.
Me and My Self-Esteem
One thing I have always suffered from and does seem to be, almost, intrinsic to the autistic mind is cripplingly low self-esteem. You think the worst of yourself no matter what evidence or information is given to you.
Low self-esteem can be caused by a multitude of factors that are not just specific to people on the spectrum. One factor is, Negative Self-Talk. Whilst a factor across all individuals, negative self-talk is found be a common feature of neurodiversity (see here for proof).
What Does Negative Self-Talk Look Like? Here is a lovely list:
Assuming: You assume the worst is going to happen and it becomes a self-fulfilling prophecy. You say to yourself, "I am going to fail this exam". So, you do not study and then you fail. Or "I am not going to get this promotion'" so you don’t put as much effort into the application or work, and you are proved correct when you are passed over. This is something that I am incredibly guilty about. ‘I am a terrible writer; no one will want to represent me’ so I do not proof-read my submission letters or my work and, as it is full of errors, I do not get a positive response. Well, I did tell myself so.
“Should” statements: "I should be cleaning the house” or “I should be doing something productive”. These statements can lead to guilt, shame and anxiety which all have a negative impact on our self-esteem and overall mental well-being. We need to be kinder to ourselves. Changing, "I should be..." to "I am doing my best" removes the feelings of guilt and shame. If keeping yourself fed and watered is all you could manage, then that is a win.
All or Nothing Thinking: This links into the autistic trait of ‘black and white thinking'. There is no middle ground. I am either going to be the best writer in the history of the world (second only to Dan Brown) or I am not going to bother. This is not ambition. Ambition creates drive and desire. This is more like planning to go for a walk and because you’re not conquering Everest, giving up.
Overgeneralising: Applying one experience to all possible outcomes. So, "I didn’t get an interview so I will never be able to get a job" or "I didn’t get a positive reply to that one submission so I will never be published".
Labelling: Giving yourself unkind, often unfair labels: "I am a loser, a bad person" etc. Often this is based on nothing more than a negative self-perception. Only a few people can truly say that they are a bad person, statistically you are not one of them.
Making Feelings Facts: You use your own negative feelings to prove your own negative perceptions. So, "I am a loser so no one will ever like me". This is not a fact; it is a feeling. Feelings are transitory and facts are immutable. Basically, Feelings are not Facts.
I have used all of these statements, and more, to justify my own lack of self-worth. These opinions were caused by not receiving the support I didn’t know I needed. Once I received my diagnosis, did all these negative thoughts go away? No. No they did not. And for some time, I added to them as I learnt to accept my new definition of myself.
All is Not Lost
If you do suffer from depression please know, you are not alone, even if it does feel like it. There are people in this world who are glad you exist. Talk to your GP or anyone that you trust. There's medications that can help and therapies. Talking about feelings can be tough for men of my generation and doubly tough if you add autism into the ‘not very fun’ cocktail. But, find the right therapist for you and therapies such as: Cognitive Behavioural Therapy (which, because The Wife is trained in, I am not allowed to criticise) or Trauma Therapy can help you change the way you think and feel. There is a plethora of treatments out there and you will find the right one for you. It is ok to be selfish sometimes.
Useful Resources
Here is a handy National Health Service guide to depression that lists the support that you can receive: Depression self-help guide | NHS inform
Autism Services Directory – The directory helps autistic people, their families and the professionals who work with them to find local and national services.
NHS Website – Information on: ASD, Signs, Symptoms, Seeking a Diagnosis and Assessment.
Suicide and Autism, a National Crisis – Article covering the statistics and strategies to combat suicide in autistic adults and children.
Autistica – Leading UK Charity with all your up to date research on ASD.
National Autistic Society – For all your rights in relation to national policy and legislation.
MIND – Information on what to do if you or someone you know is in a mental health crisis.
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